Request health profession license information confidentiality benefits

What you need for Request health profession license information confidentiality benefits

You have the right to keep your information confidential as a a victim of domestic violence, victim of adjudicated crime, or provider of services and/or training in family planning.

Learn more about the confidentiality of your health profession license information.

How to request Request health profession license information confidentiality benefits

By mail

If you qualify for information confidentiality, complete the Public Record Exemption Declaration Form and submit it to:

Bureau of Health Professions Licensure
Attention: ICP Coordinator
239 Causeway St.
5th Floor
Boston, MA 02114

Please note that you will be asked to provide an address (mailing or email) for BPHL to contact you.

Downloads for Request health profession license information confidentiality benefits

Open DOC file, 24.5 KB, for Public Record Exemption Declaration Form (DOC 24.5 KB)

Contact for Request health profession license information confidentiality benefits

Bureau of Health Professions Licensure

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Address

239 Causeway St., 5th Floor, Suite 500, Boston, MA 02114

directions 

Phone

Main: Call Bureau of Health Professions Licensure, Main: at (800) 414-0168

TTY: Call Bureau of Health Professions Licensure, TTY: at (617) 973-0988

Fax

(617) 973-0980