Provider Demographics
NPI:1588872733
Name:MAGUIRE, KAREN (LICAC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7520
Mailing Address - Country:US
Mailing Address - Phone:781-863-9565
Mailing Address - Fax:
Practice Address - Street 1:789 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3915
Practice Address - Country:US
Practice Address - Phone:781-863-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor