Provider Demographics
NPI:1003800905
Name:BROOKLINE HEARING SERVICES INC
Entity type:Organization
Organization Name:BROOKLINE HEARING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARNEVALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-232-1299
Mailing Address - Street 1:1842 BEACON ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-232-1299
Mailing Address - Fax:617-232-8959
Practice Address - Street 1:1842 BEACON ST
Practice Address - Street 2:SUITE #403
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:617-232-1299
Practice Address - Fax:617-232-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAG0026OtherBC/BS
MA007764OtherBC/BS