Healthcare Provider Details

I. General information

NPI: 1306252440
Provider Name (Legal Business Name): EMMA LASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 06/29/2026
Certification Date:
Deactivation Date: 06/14/2018
Reactivation Date: 06/29/2026

III. Provider practice location address

316 MAIN ST
OSTERVILLE MA
02655-1723
US

IV. Provider business mailing address

PO BOX 744
OSTERVILLE MA
02655-0744
US

V. Phone/Fax

Practice location:
  • Phone: 508-428-3238
  • Fax:
Mailing address:
  • Phone: 508-648-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberS94818906
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: