Provider Demographics
NPI:1467754937
Name:MARIE, CHAR (LAC)
Entity Type:Individual
Prefix:MS
First Name:CHAR
Middle Name:
Last Name:MARIE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4725
Mailing Address - Country:US
Mailing Address - Phone:203-878-9913
Mailing Address - Fax:
Practice Address - Street 1:120 BROAD STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-6212
Practice Address - Country:US
Practice Address - Phone:203-878-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist