Provider Demographics
NPI:1720825383
Name:HAM, CIARA JADAVIA
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:JADAVIA
Last Name:HAM
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 1:401 MOUNT VERNON ST APT 112
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3139
Mailing Address - Country:US
Mailing Address - Phone:857-209-6358
Mailing Address - Fax:
Practice Address - Street 1:401 MOUNT VERNON ST APT 112
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-3139
Practice Address - Country:US
Practice Address - Phone:857-209-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN