Provider Demographics
NPI:1134668486
Name:PEDDY, MARIA (CLC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PEDDY
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROOKLINE ST
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1128
Mailing Address - Country:US
Mailing Address - Phone:978-908-7914
Mailing Address - Fax:
Practice Address - Street 1:3 BROOKLINE ST
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463-1128
Practice Address - Country:US
Practice Address - Phone:978-908-7914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAALPP-232703174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN