Provider Demographics
NPI:1528394517
Name:MARTIN, ADRIENNE (LIC AC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:MARTIN
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 1:14 NASON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2598
Mailing Address - Country:US
Mailing Address - Phone:978-897-5600
Mailing Address - Fax:
Practice Address - Street 1:14 NASON ST STE 205
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2598
Practice Address - Country:US
Practice Address - Phone:978-897-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221006171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist