Provider Demographics
NPI:1386135366
Name:MCCREA, MARYANN (LAC)
Entity type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:MCCREA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TISH
Other - Middle Name:
Other - Last Name:MCCREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:44 GREEN ST.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-424-2965
Mailing Address - Fax:
Practice Address - Street 1:44 GREEN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-424-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001189171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist