Provider Demographics
NPI:1063805794
Name:UMEDA, NORIKO
Entity type:Individual
Prefix:
First Name:NORIKO
Middle Name:
Last Name:UMEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 AUCKLAND ST
Mailing Address - Street 2:APT#3
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3327
Mailing Address - Country:US
Mailing Address - Phone:310-309-1107
Mailing Address - Fax:
Practice Address - Street 1:400 HUNNEWELL ST
Practice Address - Street 2:SUITE 6R
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1360
Practice Address - Country:US
Practice Address - Phone:781-400-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11490225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist