Provider Demographics
NPI:1891119434
Name:FARNSWORTH, CRYSTAL LEE (LAC)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LEE
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEE
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:205 E CENTRAL ST STE 7
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1364
Mailing Address - Country:US
Mailing Address - Phone:508-507-8015
Mailing Address - Fax:
Practice Address - Street 1:205 E CENTRAL ST STE 7
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1364
Practice Address - Country:US
Practice Address - Phone:508-507-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261196171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist