Individual
MAXINE SOUVENIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
100 UNION ST APT 518, ELIZABETH, NJ 07202-2171
(347) 422-4370
Mailing address
100 UNION ST APT 518, ELIZABETH, NJ 07202-2171
(347) 422-4370
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT01438900
NJ
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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