Provider Demographics
NPI:1669125894
Name:BLAND, VERONICA ANDREA
Entity type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:ANDREA
Last Name:BLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-3230
Mailing Address - Country:US
Mailing Address - Phone:781-593-2727
Mailing Address - Fax:
Practice Address - Street 1:817 HEIGHTS AT CAPE ANN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5359
Practice Address - Country:US
Practice Address - Phone:978-828-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1922174226222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist