Provider Demographics
NPI:1114601424
Name:ST JACQUES, JUSTINE SALERNO (LAC)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:SALERNO
Last Name:ST JACQUES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1811 WARWICK AVE APT 34W
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-2240
Mailing Address - Country:US
Mailing Address - Phone:845-625-9170
Mailing Address - Fax:
Practice Address - Street 1:66 NOOSENECK HILL RD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1523
Practice Address - Country:US
Practice Address - Phone:401-397-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00503171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist