Healthcare Provider Details

I. General information

NPI: 1669524922
Provider Name (Legal Business Name): JUDY PHILLIPS MS,RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON STREET
BOSTON MA
02118
US

IV. Provider business mailing address

133 SUNSET ROAD
ARLINGTON MA
02474
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2040
  • Fax: 617-425-2023
Mailing address:
  • Phone: 781-641-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number205
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: