Provider Demographics
NPI:1215174180
Name:HALL, ANASTASIA (MS, LAC)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 BOYLSTON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3608
Mailing Address - Country:US
Mailing Address - Phone:347-675-8182
Mailing Address - Fax:
Practice Address - Street 1:581 BOYLSTON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3608
Practice Address - Country:US
Practice Address - Phone:347-675-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist