Provider Demographics
NPI:1316773047
Name:MOULTON, NAOMI (CCMA)
Entity type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:
Last Name:MOULTON
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2227
Mailing Address - Country:US
Mailing Address - Phone:617-596-6873
Mailing Address - Fax:
Practice Address - Street 1:79 KENWOOD ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-2227
Practice Address - Country:US
Practice Address - Phone:617-596-6873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula