Provider Demographics
NPI:1962672774
Name:DANIELS, LAURA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:DANIELS
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 1:185 DEVONSHIRE ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110
Mailing Address - Country:US
Mailing Address - Phone:617-953-3480
Mailing Address - Fax:617-507-5657
Practice Address - Street 1:185 DEVONSHIRE ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110
Practice Address - Country:US
Practice Address - Phone:617-953-3480
Practice Address - Fax:617-507-5657
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH117171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist