Provider Demographics
NPI:1760805584
Name:PICARD, MARIE JOHANNE (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:MARIE JOHANNE
Middle Name:
Last Name:PICARD
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:JOHANNE
Other - Middle Name:
Other - Last Name:PICARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, DIPL OM
Mailing Address - Street 1:360 W 125TH ST STE 2
Mailing Address - Street 2:STE. 10
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4801
Mailing Address - Country:US
Mailing Address - Phone:212-280-7900
Mailing Address - Fax:
Practice Address - Street 1:360 W 125TH ST STE 2
Practice Address - Street 2:STE. 10
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4801
Practice Address - Country:US
Practice Address - Phone:212-280-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004943171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist