Provider Demographics
NPI:1235448671
Name:COLE, STEPHEN HURLBUT (LIC AC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HURLBUT
Last Name:COLE
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 DAVIS AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 DAVIS AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6042
Practice Address - Country:US
Practice Address - Phone:617-232-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist