Provider Demographics
NPI:1366853269
Name:BRACKEN, LAURA DELANCEY (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DELANCEY
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 E MAIN ST STE 404
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5295
Mailing Address - Country:US
Mailing Address - Phone:410-857-6155
Mailing Address - Fax:
Practice Address - Street 1:79 E MAIN ST STE 404
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5295
Practice Address - Country:US
Practice Address - Phone:410-857-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02145171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist