Basic Information
| Provider Information | |||||||||
| NPI: | 1396976064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCIER | ||||||||
| FirstName: | TRACEY | ||||||||
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| Credential: | RD, LDN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 WINTER ST | ||||||||
| Address2: | |||||||||
| City: | REHOBOTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027691734 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 JOSLIN PLACE | ||||||||
| Address2: | JOSLIN DIABETES CENTER | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177322665 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2009 | ||||||||
| LastUpdateDate: | 07/29/2009 | ||||||||
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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 | 2539 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.