Provider Demographics
NPI:1275540668
Name:SHAPIRO, MAXINE M (LIC AC)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:F
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 1:856 WATERTOWN ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2140
Mailing Address - Country:US
Mailing Address - Phone:617-965-5251
Mailing Address - Fax:617-395-2621
Practice Address - Street 1:856 WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2140
Practice Address - Country:US
Practice Address - Phone:617-965-5251
Practice Address - Fax:617-395-2621
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0042171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist