Provider Demographics
NPI:1003068883
Name:LEBOEUF, CHRISTINA (LICAC, MAOM)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LEBOEUF
Suffix:
Gender:F
Credentials:LICAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1905
Mailing Address - Country:US
Mailing Address - Phone:315-769-7610
Mailing Address - Fax:
Practice Address - Street 1:172 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1905
Practice Address - Country:US
Practice Address - Phone:315-769-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003895171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist