Provider Demographics
NPI:1669523544
Name:LAWRENCE, CINDY J (MAOM, LICAC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:J
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MAOM, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 BRIDGEPORT AVE
Mailing Address - Street 2:SUITE C, 2ND FLOOR
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4622
Mailing Address - Country:US
Mailing Address - Phone:203-887-6789
Mailing Address - Fax:203-374-9269
Practice Address - Street 1:1077 BRIDGEPORT AVE
Practice Address - Street 2:SUITE C, 2ND FLOOR
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4622
Practice Address - Country:US
Practice Address - Phone:203-887-6789
Practice Address - Fax:203-374-9269
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist