Healthcare Provider Details

I. General information

NPI: 1992378939
Provider Name (Legal Business Name): CARLEE LYNN LAPORTE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 11/27/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 HOWARD ST
NEW LONDON CT
06320-5544
US

IV. Provider business mailing address

27 S COBBLERS CT
NIANTIC CT
06357-1322
US

V. Phone/Fax

Practice location:
  • Phone: 860-444-4737
  • Fax:
Mailing address:
  • Phone: 860-859-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1896
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: