Provider Demographics
NPI:1760690747
Name:TRAVAGLIONE, MARYANNE (LAC)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:TRAVAGLIONE
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 1:12 W 27TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6903
Mailing Address - Country:US
Mailing Address - Phone:212-675-9355
Mailing Address - Fax:212-675-9381
Practice Address - Street 1:12 W 27TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6903
Practice Address - Country:US
Practice Address - Phone:212-675-9355
Practice Address - Fax:212-675-9381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000561171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist