Provider Demographics
NPI:1265582381
Name:DONLIN, MARISA P (LIC AC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:P
Last Name:DONLIN
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 1:111 GREEN ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2258
Mailing Address - Country:US
Mailing Address - Phone:617-899-2692
Mailing Address - Fax:
Practice Address - Street 1:111 GREEN ST UNIT 201
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2258
Practice Address - Country:US
Practice Address - Phone:617-899-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226466171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist