Healthcare Provider Details

I. General information

NPI: 1295866929
Provider Name (Legal Business Name): KAREN SYBERTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN ST
BROCKTON MA
02301-4012
US

IV. Provider business mailing address

304 HARVARD ST
E BRIDGEWATER MA
02333-1112
US

V. Phone/Fax

Practice location:
  • Phone: 508-559-6699
  • Fax: 508-583-4649
Mailing address:
  • Phone: 508-690-1404
  • Fax: 508-583-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: