Provider Demographics
NPI:1912188798
Name:VINCENT, CATHLEEN P (LIC AC)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:P
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 A VICENT ROAD
Mailing Address - Street 2:
Mailing Address - City:VINYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568
Mailing Address - Country:US
Mailing Address - Phone:508-696-1863
Mailing Address - Fax:
Practice Address - Street 1:455 STATE RD
Practice Address - Street 2:UNIT # 12
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5695
Practice Address - Country:US
Practice Address - Phone:508-696-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227937171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist