Healthcare Provider Details

I. General information

NPI: 1386099182
Provider Name (Legal Business Name): LACTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 EISENHOWER RD
NORWOOD MA
02062-3648
US

IV. Provider business mailing address

24 EISENHOWER RD
NORWOOD MA
02062-3648
US

V. Phone/Fax

Practice location:
  • Phone: 617-778-8654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN264681
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberL-48567
License Number StateMA

VIII. Authorized Official

Name: KELLY SHEEHAN
Title or Position: LACTATION CONSULTANT
Credential: RN, IBCLC
Phone: 617-778-8654