Provider Demographics
NPI:1770832081
Name:PLACE, EMILY MARGARET (LCGC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARGARET
Last Name:PLACE
Suffix:
Gender:F
Credentials:LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHARLES ST
Mailing Address - Street 2:PIERCE LAB, ROOM 501A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-6902
Mailing Address - Fax:617-573-6901
Practice Address - Street 1:243 CHARLES ST
Practice Address - Street 2:PIERCE LAB, ROOM 501A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-6902
Practice Address - Fax:617-573-6901
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC170170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS