Healthcare Provider Details

I. General information

NPI: 1487448908
Provider Name (Legal Business Name): MOMMAS DOULA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HUMBOLDT AVE
DORCHESTER MA
02121-1236
US

IV. Provider business mailing address

140 HUMBOLDT AVE # 3
DORCHESTER MA
02121-1236
US

V. Phone/Fax

Practice location:
  • Phone: 857-309-0711
  • Fax:
Mailing address:
  • Phone: 857-381-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347D00000X
TaxonomyTrain
License Number
License Number State

VIII. Authorized Official

Name: TATIKQUA AUSTIN
Title or Position: CEO
Credential:
Phone: 857-381-4200