Provider Demographics
NPI:1538329214
Name:PATNOD, DENISE M (LIC AC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:PATNOD
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 1:151 COOLIDGE AVE
Mailing Address - Street 2:#612
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2881
Mailing Address - Country:US
Mailing Address - Phone:617-820-6864
Mailing Address - Fax:
Practice Address - Street 1:22 HILLIAND STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-820-6864
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
MA223634171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist