Provider Demographics
NPI:1376693069
Name:ROTHSTEIN, JOANNE VIRGINIA (LIC AC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:VIRGINIA
Last Name:ROTHSTEIN
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 1:31 ROBIN HOOD RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-1240
Mailing Address - Country:US
Mailing Address - Phone:781-646-7073
Mailing Address - Fax:
Practice Address - Street 1:20 CUMMINGS PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2122
Practice Address - Country:US
Practice Address - Phone:617-771-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist