Provider Demographics
NPI:1407924244
Name:GROSSMAN, NANCY E (LIC AC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:GROSSMAN
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:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-0044
Mailing Address - Country:US
Mailing Address - Phone:413-585-1511
Mailing Address - Fax:
Practice Address - Street 1:441 WEST ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2997
Practice Address - Country:US
Practice Address - Phone:413-585-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist