Provider Demographics
NPI:1144782566
Name:LENNON, COURTNEY ANN
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:LENNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FAWCETT ST UNIT 413
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1188
Mailing Address - Country:US
Mailing Address - Phone:860-944-6158
Mailing Address - Fax:
Practice Address - Street 1:90 FAWCETT ST UNIT 413
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1188
Practice Address - Country:US
Practice Address - Phone:860-944-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist