Provider Demographics
NPI:1174677249
Name:DEA, CHRISTINA L (LIC AC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:DEA
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 1:22 RICE ST
Mailing Address - Street 2:#2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1817
Mailing Address - Country:US
Mailing Address - Phone:617-271-7727
Mailing Address - Fax:
Practice Address - Street 1:22 RICE ST
Practice Address - Street 2:#2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1817
Practice Address - Country:US
Practice Address - Phone:617-271-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230156171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist