Healthcare Provider Details

I. General information

NPI: 1497995567
Provider Name (Legal Business Name): MARCELLA ROBINSON LAC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LAGRANGE AVE SUITE 201
POUGHKEEPSIE NY
12603-8911
US

IV. Provider business mailing address

68 GERALD DR APT F2
POUGHKEEPSIE NY
12601-2923
US

V. Phone/Fax

Practice location:
  • Phone: 917-232-3949
  • Fax:
Mailing address:
  • Phone: 917-232-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2503
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1418
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number52483
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number011658
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: