Provider Demographics
NPI:1699197228
Name:LENSSEN, HENRIETTE AGNES (LAC)
Entity Type:Individual
Prefix:
First Name:HENRIETTE
Middle Name:AGNES
Last Name:LENSSEN
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 1:1428 BERKELEY WAY # A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1520
Mailing Address - Country:US
Mailing Address - Phone:510-786-8872
Mailing Address - Fax:
Practice Address - Street 1:1676 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1455
Practice Address - Country:US
Practice Address - Phone:510-786-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist