Healthcare Provider Details

I. General information

NPI: 1215348800
Provider Name (Legal Business Name): CHILD DEVELOPMENT PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 MASSACHUSETTS AVE
LEXINGTON MA
02420-3900
US

IV. Provider business mailing address

36 LAKE WARREN DR
LITTLETON MA
01460-1506
US

V. Phone/Fax

Practice location:
  • Phone: 978-501-2833
  • Fax:
Mailing address:
  • Phone: 978-501-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7759
License Number StateMA

VIII. Authorized Official

Name: DR. SUSAN M GIURLEO
Title or Position: CO-FOUNDER
Credential: PHD
Phone: 978-501-2833