Healthcare Provider Details

I. General information

NPI: 1902034697
Provider Name (Legal Business Name): CORIN KENNEDY-SPIELMAN B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HAMMOND PL
MEDFORD MA
02155-2232
US

IV. Provider business mailing address

13 TEMPLE ST
QUINCY MA
02169-5110
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: