Healthcare Provider Details

I. General information

NPI: 1568562635
Provider Name (Legal Business Name): JEAN M CARR R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE PRESTON 2
BOSTON MA
02118-2309
US

IV. Provider business mailing address

46 MEDFORD ST #2
CHELSEA MA
02150-2615
US

V. Phone/Fax

Practice location:
  • Phone: 618-638-5985
  • Fax: 617-638-7449
Mailing address:
  • Phone: 617-889-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number38
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: