Basic Information
| Provider Information | |||||||||
| NPI: | 1578076725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALTOUMAS | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, RDN, LDN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | REED | ||||||||
| OtherFirstName: | JANICE | ||||||||
| OtherMiddleName: | S. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | ELEMENT CARE INC. | ||||||||
| Address2: | 37 FRIEND STREET | ||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817156608 | ||||||||
| FaxNumber: | 7817156699 | ||||||||
| Practice Location | |||||||||
| Address1: | ELEMENT CARE INC. | ||||||||
| Address2: | 37 FRIEND STREET | ||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814172112 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2017 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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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 | 1189 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.