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General NPI Number Information
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NPI Number | 1033596259
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Entity Type | Organization
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Legal Business Name | FABULOUS BIRTH SUPPORT
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 2655 8TH AVE APT 4N
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City | NEW YORK
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State | NY
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Zip | 10030-1536
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Country | US
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Telephone | 562-774-3289
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 8TH AVE APT 4N
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City | NEW YORK
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State | NY
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Zip | 10030-1536
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Country | US
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Telephone | 562-774-3289
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Fax |
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Authorized Official
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Title or Position | FOUNDING DIRECTOR AND DOULA
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Name | MS. ALISON WONDERLAND BACICH
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Credential | CLC
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Telephone | 562-774-3289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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