Provider Demographics
NPI:1710632195
Name:MAHER, MARISA (DACM, MSAOM, LAC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:DACM, MSAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2356
Mailing Address - Country:US
Mailing Address - Phone:315-308-0690
Mailing Address - Fax:
Practice Address - Street 1:5016 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2356
Practice Address - Country:US
Practice Address - Phone:315-308-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006760171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty