Provider Demographics
NPI:1730123225
Name:FEMINO, LOUIS ANTHONY (MACCC-A)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:ANTHONY
Last Name:FEMINO
Suffix:
Gender:M
Credentials:MACCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5022
Mailing Address - Country:US
Mailing Address - Phone:781-224-1416
Mailing Address - Fax:781-224-7637
Practice Address - Street 1:306 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5022
Practice Address - Country:US
Practice Address - Phone:781-224-1416
Practice Address - Fax:781-224-7637
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA803231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5104475Medicaid
MAFE044364Medicare PIN