Provider Demographics
NPI:1568646081
Name:MINUTEMAN ARC EARLY INTERVENTION
Entity Type:Organization
Organization Name:MINUTEMAN ARC EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:VIENNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:978-287-7800
Mailing Address - Street 1:8 ACTON ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741
Mailing Address - Country:US
Mailing Address - Phone:978-369-2649
Mailing Address - Fax:
Practice Address - Street 1:8 ACTON ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:MA
Practice Address - Zip Code:01741-1436
Practice Address - Country:US
Practice Address - Phone:978-369-2649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1474252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency