Basic Information
Provider Information
NPI: 1649453598
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MALONEY
FirstName: APRIL
MiddleName: HAEFNER
NamePrefix: MS.
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 61 MEDFORD ST
Address2:  
City: SOMERVILLE
State: MA
PostalCode: 021433421
CountryCode: US
TelephoneNumber: 6176293919
FaxNumber: 6176294644
Practice Location
Address1: 61 MEDFORD ST
Address2:  
City: SOMERVILLE
State: MA
PostalCode: 021433421
CountryCode: US
TelephoneNumber: 6176293919
FaxNumber: 6176294644
Other Information
ProviderEnumerationDate: 12/14/2007
LastUpdateDate: 12/17/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Q00000X22Q00000XMAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 

No ID Information.


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