Healthcare Provider Details

I. General information

NPI: 1669389581
Provider Name (Legal Business Name): ASHLEY LANDREIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 BOSTON AVE STE 2000
MEDFORD MA
02155-4260
US

IV. Provider business mailing address

101 MORSE ST APT G1
WATERTOWN MA
02472-1638
US

V. Phone/Fax

Practice location:
  • Phone: 631-495-2731
  • Fax:
Mailing address:
  • Phone: 631-495-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: