Provider Demographics
NPI:1013395284
Name:MOMMY & BABY WELLNESS PATH
Entity Type:Organization
Organization Name:MOMMY & BABY WELLNESS PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARY LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-468-2245
Mailing Address - Street 1:11 CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2508
Mailing Address - Country:US
Mailing Address - Phone:201-468-2245
Mailing Address - Fax:
Practice Address - Street 1:11 CLARK CIR
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2508
Practice Address - Country:US
Practice Address - Phone:201-468-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276431261QC1500X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty