Provider Demographics
NPI:1649598939
Name:SEPICH, MARIE (LAC)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:SEPICH
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 1:339 9TH ST
Mailing Address - Street 2:#2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4054
Mailing Address - Country:US
Mailing Address - Phone:347-489-7622
Mailing Address - Fax:
Practice Address - Street 1:339 9TH ST APT 3R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4054
Practice Address - Country:US
Practice Address - Phone:347-489-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25-003873171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist