Basic Information
| Provider Information | |||||||||
| NPI: | 1033635016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARD | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 FRIEND STREET | ||||||||
| Address2: | ELEMENT CARE INC | ||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817156608 | ||||||||
| FaxNumber: | 7817156699 | ||||||||
| Practice Location | |||||||||
| Address1: | 62 MARKET STREET | ||||||||
| Address2: | |||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817156530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 08/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 932062 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.