Provider Demographics
NPI:1003197476
Name:GALVIN, JAMIE L (LICAC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:L
Last Name:GALVIN
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2123
Mailing Address - Country:US
Mailing Address - Phone:617-838-4505
Mailing Address - Fax:617-646-3634
Practice Address - Street 1:1030 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2123
Practice Address - Country:US
Practice Address - Phone:617-838-4505
Practice Address - Fax:617-646-3436
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250901171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist