Provider Demographics
NPI:1336784974
Name:URENA, JOSEFINA (LMT, RT (R))
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:URENA
Suffix:
Gender:F
Credentials:LMT, RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PLEASANT ST # 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2243
Mailing Address - Country:US
Mailing Address - Phone:978-590-7292
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST STE G4
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5077
Practice Address - Country:US
Practice Address - Phone:978-590-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
MA14488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist