Individual
BRIANNA MICCICHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 CONDOR ST, EAST BOSTON, MA 02128-1305
(617) 569-6560
Mailing address
130 CONDOR ST, EAST BOSTON, MA 02128-1305
(617) 569-6560
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
MA
Other
Enumeration date
06/06/2014
Last updated
06/06/2014
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