Healthcare Provider Details

I. General information

NPI: 1104478247
Provider Name (Legal Business Name): KATHLEEN E. WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANIFORD ST STE 430
BOSTON MA
02114-2541
US

IV. Provider business mailing address

420 KENT AVE APT PH21
BROOKLYN NY
11249-5665
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-4400
  • Fax:
Mailing address:
  • Phone: 516-509-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4803
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: