MEDICARE: CONSERVATORY LAB CHARTER SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1801926142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSERVATORY LAB CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	25 ARLINGTON ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-2124
Country	:	US
Telephone Number	:
Fax Number	:	617-254-8909

Provider Business Practice Location Address
First Line	:	25 ARLINGTON ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-2124
Country	:	US
Telephone Number	:	617-254-8904
Fax Number	:	617-254-8909

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. ROSALIE STONE
Credential	:
Telephone Number	:	617-254-8904

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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Directions to “CONSERVATORY LAB CHARTER SCHOOL ” Practice Location

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