Provider Demographics
NPI:1306983788
Name:PANARESE, SUSAN (LICAC,MAC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PANARESE
Suffix:
Gender:F
Credentials:LICAC,MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NAHANT ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3325
Mailing Address - Country:US
Mailing Address - Phone:781-592-4634
Mailing Address - Fax:
Practice Address - Street 1:2 ELECTRONICS AVE STE 1
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1071
Practice Address - Country:US
Practice Address - Phone:978-777-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA626171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist