Provider Demographics
NPI:1205086238
Name:COLYN, ANNE J (LIC AC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:J
Last Name:COLYN
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 1:12 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-1440
Mailing Address - Country:US
Mailing Address - Phone:617-650-9658
Mailing Address - Fax:
Practice Address - Street 1:12 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-1440
Practice Address - Country:US
Practice Address - Phone:617-650-9658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist