Provider Demographics
NPI:1033423728
Name:MURPHY, LESLIE CARBONE (LICAC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CARBONE
Last Name:MURPHY
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 1:77 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2913
Mailing Address - Country:US
Mailing Address - Phone:617-794-4835
Mailing Address - Fax:
Practice Address - Street 1:70 E GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1810
Practice Address - Country:US
Practice Address - Phone:617-794-4835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239588171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist