Individual
MISS DERMELINE BOURCIQUOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
280 BRIDGE ST STE 110, DEDHAM, MA 02026-1759
(781) 326-4207
Mailing address
23 CYPRESS RD, MEDFORD, MA 02155-2505
(339) 545-6466
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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