Provider Demographics
NPI:1174828149
Name:CORRIGAN, LAURA (LICAC, MAOM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LICAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4404
Mailing Address - Country:US
Mailing Address - Phone:617-868-0756
Mailing Address - Fax:
Practice Address - Street 1:21 BELMONT ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4404
Practice Address - Country:US
Practice Address - Phone:617-868-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist