Provider Demographics
NPI:1013426204
Name:MODERN MAMA
Entity Type:Organization
Organization Name:MODERN MAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SCHAMELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:860-919-5563
Mailing Address - Street 1:21 AQUAVIA RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1002
Mailing Address - Country:US
Mailing Address - Phone:860-919-5563
Mailing Address - Fax:617-765-7318
Practice Address - Street 1:21 AQUAVIA RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1002
Practice Address - Country:US
Practice Address - Phone:860-919-5563
Practice Address - Fax:617-765-7318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty