Provider Demographics
NPI:1265757066
Name:ROBISON, KRISTIN ARDELLA (LAC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ARDELLA
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ADDINGTON RD
Mailing Address - Street 2:#1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4500
Mailing Address - Country:US
Mailing Address - Phone:857-225-2389
Mailing Address - Fax:
Practice Address - Street 1:122 ADDINGTON RD
Practice Address - Street 2:#1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4500
Practice Address - Country:US
Practice Address - Phone:857-225-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist