Healthcare Provider Details

I. General information

NPI: 1891002200
Provider Name (Legal Business Name): BRONWYN BIRD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 GORDON ST APT 1
SOMERVILLE MA
02144-1110
US

IV. Provider business mailing address

26 GORDON ST APT 1
SOMERVILLE MA
02144-1110
US

V. Phone/Fax

Practice location:
  • Phone: 617-482-7494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: