Healthcare Provider Details

I. General information

NPI: 1174669709
Provider Name (Legal Business Name): CORINNE LIVINGSTON ADLER RD LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 CLARENDON SUITE 2
BOSTON MA
02116
US

IV. Provider business mailing address

210 BEACON STREET SUITE 4
BOSTON MA
02116
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-7111
  • Fax:
Mailing address:
  • Phone: 617-236-1035
  • Fax: 617-247-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberR116500
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number832755
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR116500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: