Healthcare Provider Details

I. General information

NPI: 1740316868
Provider Name (Legal Business Name): LYNDA POLINO CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNDA SEIFER M.S. CCC-SLP

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BORDER ST
EAST BOSTON MA
02128-2432
US

IV. Provider business mailing address

21 GEORGE ST
WINTHROP MA
02152-3109
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax:
Mailing address:
  • Phone: 617-207-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6945
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: