Organization
HAIR LOSS CENTER OF BOSTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIMENE CAROLE NGNINTOUNDEM (OWNER)
(617) 319-8773
Entity
Organization
Contact information
Practice address
117 MAIN ST STE 48, STONEHAM, MA 02180-3305
(800) 484-7017
Mailing address
117 MAIN ST STE 48, STONEHAM, MA 02180-3305
(800) 484-7017
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012543
TRICHOLOGIST LICENSE
MA
Enumeration date
09/17/2020
Last updated
04/12/2021
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