Healthcare Provider Details

I. General information

NPI: 1740479682
Provider Name (Legal Business Name): ERICA CINTRON OUELLETTE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 CONIFER HILL DR
DANVERS MA
01923-1193
US

IV. Provider business mailing address

147 S MAIN ST
MIDDLETON MA
01949-2446
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-2555
  • Fax: 978-774-8715
Mailing address:
  • Phone: 978-774-2555
  • Fax: 978-774-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number926862
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2587
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: