Provider Demographics
NPI:1508159062
Name:NORMAN, MARIA CARPENTER (LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARPENTER
Last Name:NORMAN
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 1:79 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1750
Mailing Address - Country:US
Mailing Address - Phone:315-719-4412
Mailing Address - Fax:
Practice Address - Street 1:402 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1020
Practice Address - Country:US
Practice Address - Phone:315-719-4412
Practice Address - Fax:585-394-3567
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004579171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist