Individual
MIRIAM N HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23 BRADSTON ST, BOSTON, MA 02118-2703
(617) 318-6480
(617) 427-1263
Mailing address
23 BRADSTON ST, BOSTON, MA 02118-2703
(617) 318-6480
(617) 427-1263
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
LN64374
MA
Other
Enumeration date
03/30/2021
Last updated
03/30/2021
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