Provider Demographics
NPI:1134397573
Name:LEGAULT, MARIANE E (LIC AC)
Entity type:Individual
Prefix:
First Name:MARIANE
Middle Name:E
Last Name:LEGAULT
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:FIRST CHOICE HEALTH CENTER
Mailing Address - Street 2:266 CABOT STREET - SUITE II
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-0831
Mailing Address - Fax:
Practice Address - Street 1:FIRST CHOICE HEALTH CENTER
Practice Address - Street 2:266 CABOT STREET - SUITE II
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist