Provider Demographics
NPI:1831266568
Name:CASINELLI, DARIA (LIC AC)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:CASINELLI
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 1:1197 ADAMS ST APT NO1L
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5855
Mailing Address - Country:US
Mailing Address - Phone:617-312-7650
Mailing Address - Fax:
Practice Address - Street 1:1197 ADAMS ST FL 3
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5855
Practice Address - Country:US
Practice Address - Phone:617-312-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist