Basic Information
| Provider Information | |||||||||
| NPI: | 1811353634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOESCHEL | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, RD, IBCLC, CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 MONTICELLO DR | ||||||||
| Address2: | |||||||||
| City: | EAST LYME | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063331228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602356177 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 374 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065133733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037777411 | ||||||||
| FaxNumber: | 2034012044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2016 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 860645 | RI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.