Provider Demographics
NPI:1932437100
Name:BLAISDELL, ALLISON ANNE (LICAC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:BLAISDELL
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:BLAISDELL
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICAC
Mailing Address - Street 1:82 BREMEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1904
Mailing Address - Country:US
Mailing Address - Phone:617-792-2913
Mailing Address - Fax:
Practice Address - Street 1:82 BREMEN ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1904
Practice Address - Country:US
Practice Address - Phone:617-792-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist