Provider Demographics
NPI:1992920359
Name:WALSH, COREEN (LIC AC)
Entity type:Individual
Prefix:
First Name:COREEN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ACUPUNCTURE SOLUTIONS
Mailing Address - Street 2:TWO EAST INDIA SQUARE, # 149
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-744-1600
Mailing Address - Fax:
Practice Address - Street 1:ACUPUNCTURE SOLUTIONS
Practice Address - Street 2:TWO EAST INDIA SQUARE, # 149
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-744-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist