Provider Demographics
NPI:1639347032
Name:FREITAS, JOHN J (LIC AC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:FREITAS
Suffix:
Gender:M
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 1:169 WESTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-9787
Mailing Address - Country:US
Mailing Address - Phone:413-265-1451
Mailing Address - Fax:
Practice Address - Street 1:169 WESTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-9787
Practice Address - Country:US
Practice Address - Phone:413-265-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist