Provider Demographics
NPI:1427218163
Name:FAY, ELIZABETH M (LIC AC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:FAY
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 1:51 RADCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6605
Mailing Address - Country:US
Mailing Address - Phone:617-519-9500
Mailing Address - Fax:
Practice Address - Street 1:697 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1388
Practice Address - Country:US
Practice Address - Phone:617-519-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216402171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist