Provider Demographics
NPI:1023492105
Name:LENARD, ROBERTA NMI (MAOM (PENDING))
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:NMI
Last Name:LENARD
Suffix:
Gender:F
Credentials:MAOM (PENDING)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-5103
Mailing Address - Country:US
Mailing Address - Phone:617-645-9940
Mailing Address - Fax:
Practice Address - Street 1:471 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-5103
Practice Address - Country:US
Practice Address - Phone:617-645-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist