Provider Demographics
NPI:1063218436
Name:HADDAD, LAILA ALICE (LAC, DAC,)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:ALICE
Last Name:HADDAD
Suffix:
Gender:
Credentials:LAC, DAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3420
Mailing Address - Country:US
Mailing Address - Phone:617-834-3124
Mailing Address - Fax:
Practice Address - Street 1:48 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3420
Practice Address - Country:US
Practice Address - Phone:617-834-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6014072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist