Provider Demographics
NPI:1861893950
Name:LACZYNSKI, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LACZYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 LYNNE LN
Mailing Address - Street 2:
Mailing Address - City:MAPLEVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02839-1118
Mailing Address - Country:US
Mailing Address - Phone:401-573-9114
Mailing Address - Fax:
Practice Address - Street 1:289 LYNNE LN
Practice Address - Street 2:
Practice Address - City:MAPLEVILLE
Practice Address - State:RI
Practice Address - Zip Code:02839-1118
Practice Address - Country:US
Practice Address - Phone:401-573-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer