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General NPI Number Information
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NPI Number | 1912259136
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Entity Type | Individual
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Provider Name | BRANDEE ILENE GOING LAC,LMT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 93 MARKET SQ
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City | NEWINGTON
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State | CT
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Zip | 06111-2900
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Country | US
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Telephone | 860-578-9865
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 SAYBROOK RD
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City | HADDAM
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State | CT
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Zip | 06438-1324
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Country | US
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Telephone | 860-304-9809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 554
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License Number State | CT
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