Provider Demographics
NPI:1912145665
Name:CORNISH, MAREN E (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MAREN
Middle Name:E
Last Name:CORNISH
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 EAST AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4902
Mailing Address - Country:US
Mailing Address - Phone:203-354-9849
Mailing Address - Fax:203-354-9850
Practice Address - Street 1:83 EAST AVE STE 309
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4902
Practice Address - Country:US
Practice Address - Phone:203-354-9849
Practice Address - Fax:203-354-9850
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000520171100000X
CT000407175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist