Provider Demographics
NPI:1184805665
Name:BROSKI, ANN L (LCMT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:BROSKI
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WORTHEN RD STE 1-1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4835
Mailing Address - Country:US
Mailing Address - Phone:781-541-6301
Mailing Address - Fax:
Practice Address - Street 1:21 WORTHEN RD STE 1-1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4835
Practice Address - Country:US
Practice Address - Phone:781-541-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist