Healthcare Provider Details

I. General information

NPI: 1033151410
Provider Name (Legal Business Name): JUDITH G. D'AFFLITTI M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WASHINGTON ST SUITE 210
WELLESLEY HILLS MA
02481-1803
US

IV. Provider business mailing address

42 PLAINFIELD ST
NEWTON MA
02468-1618
US

V. Phone/Fax

Practice location:
  • Phone: 781-239-9700
  • Fax:
Mailing address:
  • Phone: 617-964-5085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number15719
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: