Provider Demographics
NPI:1396878351
Name:ROTHBERG, LYNN DECOURSEY (LIC AC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:DECOURSEY
Last Name:ROTHBERG
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 1:5 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2436
Mailing Address - Country:US
Mailing Address - Phone:508-478-4121
Mailing Address - Fax:
Practice Address - Street 1:360 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1826
Practice Address - Country:US
Practice Address - Phone:508-429-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA421171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist