Healthcare Provider Details

I. General information

NPI: 1447744313
Provider Name (Legal Business Name): CATHERINE BARRY IBCLC, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE FANNING RD

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 MAIN ST
ACTON MA
01720-3810
US

IV. Provider business mailing address

128 MAGAZINE ST APT 16
CAMBRIDGE MA
02139-3920
US

V. Phone/Fax

Practice location:
  • Phone: 978-621-4408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86010485
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310853
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: