Provider Demographics
NPI:1447436068
Name:MYERS, JUSTINE DEUTSCH (LIC AC)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:DEUTSCH
Last Name:MYERS
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:MISS
Other - First Name:JUSTINE
Other - Middle Name:LINEAL
Other - Last Name:DEUTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC AC
Mailing Address - Street 1:2464 MASSACHUSETTS AVENUE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140
Mailing Address - Country:US
Mailing Address - Phone:617-499-9993
Mailing Address - Fax:617-499-9950
Practice Address - Street 1:2464 MASSACHUSETTS AVENUE
Practice Address - Street 2:SUITE 420
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:617-499-9993
Practice Address - Fax:617-499-9950
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233819171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist