Individual
MS. LUCELIN FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
390 43RD ST, COPIAGUE, NY 11726-1120
(631) 398-5829
Mailing address
390 43RD ST, COPIAGUE, NY 11726-1120
(631) 398-5829
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
021723
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021723
NYS LICENSED MASSAGE THERAPIST
NY
Enumeration date
01/17/2010
Last updated
01/17/2010
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