Provider Demographics
NPI:1114139086
Name:WALSH, ELAINE G (LICAC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:G
Last Name:WALSH
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 EDWARDS ST
Mailing Address - Street 2:#1
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4963
Mailing Address - Country:US
Mailing Address - Phone:978-927-2664
Mailing Address - Fax:978-927-3226
Practice Address - Street 1:2 EDWARDS ST
Practice Address - Street 2:#1
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4963
Practice Address - Country:US
Practice Address - Phone:978-927-2664
Practice Address - Fax:978-927-3226
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA633171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist