Healthcare Provider Details

I. General information

NPI: 1184970154
Provider Name (Legal Business Name): LAUREN ELIZABETH MASTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 06/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 FORTUNE BLVD
MILFORD MA
01757-1723
US

IV. Provider business mailing address

10 SOUTHPINE RD
FRANKLIN MA
02038-3332
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-7752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number77238-SP-SL
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: