Basic Information
| Provider Information | |||||||||
| NPI: | 1669524922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | JUDY | ||||||||
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| Credential: | MS,RD,LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 SUNSET ROAD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816411138 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174252040 | ||||||||
| FaxNumber: | 6174252023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 133N00000X | 205 | MA | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.