Healthcare Provider Details

I. General information

NPI: 1679483184
Provider Name (Legal Business Name): THERESE RONCO L.AC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FOREST FALLS DR STE 1
YARMOUTH ME
04096-6971
US

IV. Provider business mailing address

29 SAINT LAWRENCE ST APT 2
PORTLAND ME
04101-4340
US

V. Phone/Fax

Practice location:
  • Phone: 207-358-0252
  • Fax:
Mailing address:
  • Phone: 617-947-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC895
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: