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Organization

CHILD DEVELOPMENT NETWORK, LLC

Active
Other names
Child Development Network
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JANINE KORAHAIS STASIOR PHD, MS (OWNER)
(781) 861-6655
Entity
Organization

Contact information

Practice address
76 BEDFORD ST STE 12, LEXINGTON, MA 02420-4640
(781) 861-6655
(781) 861-6654
Mailing address
76 BEDFORD ST STE 12, LEXINGTON, MA 02420-4640
(781) 861-6655
(781) 861-6654

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
6645
MA
235Z00000X
Speech-Language Pathologist
Primary
6653
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
SG0044
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/30/2007
Last updated
08/30/2007
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