Provider Demographics
NPI:1780111229
Name:BAUDELAIRE, MILAN A (LMT, CLDP)
Entity type:Individual
Prefix:MS
First Name:MILAN
Middle Name:A
Last Name:BAUDELAIRE
Suffix:
Gender:F
Credentials:LMT, CLDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DEERFIELD ST UNIT 15206
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5609
Mailing Address - Country:US
Mailing Address - Phone:617-505-4049
Mailing Address - Fax:
Practice Address - Street 1:20 CHARLESGATE W APT 320
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2703
Practice Address - Country:US
Practice Address - Phone:617-959-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist