Provider Demographics
NPI:1245394337
Name:GHAREEB, CORNELIA M (MAC, LIC AC)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:M
Last Name:GHAREEB
Suffix:
Gender:F
Credentials:MAC, LIC AC
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:GHAREEB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAC, LIC AC
Mailing Address - Street 1:22 WOBURN ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867
Mailing Address - Country:US
Mailing Address - Phone:781-324-3900
Mailing Address - Fax:
Practice Address - Street 1:335 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:781-324-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA593171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist