Provider Demographics
NPI:1033151410
Name:D'AFFLITTI, JUDITH G (MSN)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:G
Last Name:D'AFFLITTI
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PLAINFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1618
Mailing Address - Country:US
Mailing Address - Phone:617-964-5085
Mailing Address - Fax:
Practice Address - Street 1:42 WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-1803
Practice Address - Country:US
Practice Address - Phone:781-239-9700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15719163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0192Medicare ID - Type Unspecified