- This page, Request health profession license information confidentiality benefits, is offered by
- Bureau of Health Professions Licensure
- Department of Public Health
Request health profession license information confidentiality benefits
Under certain circumstance, you may request to have your home address, home telephone number, place of employment, and place of education exempt from public records disclosure.
Contact for Request health profession license information confidentiality benefits
Bureau of Health Professions Licensure
The Details of 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
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
250 Washington St.
Boston, MA 02108
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 DOCX file, 31.98 KB, for
Public Record Exemption Declaration Form
(English, DOCX 31.98 KB)
Contact for Request health profession license information confidentiality benefits
Address
250 Washington St., Boston, MA 02108
Phone
Fax
(617) 973-0980