Provider Demographics
NPI:1558438283
Name:FIUTEM, STACEY L (LIC AC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:FIUTEM
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 1:13 MERYL ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1819
Mailing Address - Country:US
Mailing Address - Phone:774-233-0446
Mailing Address - Fax:
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-3211
Practice Address - Country:US
Practice Address - Phone:774-233-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212120171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist