Provider Demographics
NPI:1013225010
Name:LAUTENBACH, DENISE M (MS)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:M
Last Name:LAUTENBACH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 E CONCORD ST
Mailing Address - Street 2:B-7800
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2307
Mailing Address - Country:US
Mailing Address - Phone:617-638-5355
Mailing Address - Fax:617-414-1197
Practice Address - Street 1:72 E CONCORD ST
Practice Address - Street 2:B-7800
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2307
Practice Address - Country:US
Practice Address - Phone:617-638-5355
Practice Address - Fax:617-414-1197
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS