Provider Demographics
NPI:1780703488
Name:THOMASON, CATHY E (LIC AC)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:E
Last Name:THOMASON
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 1:199 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3828
Mailing Address - Country:US
Mailing Address - Phone:617-852-0690
Mailing Address - Fax:
Practice Address - Street 1:278 ELM ST STE 227
Practice Address - Street 2:GREAT WAY WELLNESS CENTER
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2941
Practice Address - Country:US
Practice Address - Phone:617-852-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219558171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist