Healthcare Provider Details

I. General information

NPI: 1558571901
Provider Name (Legal Business Name): MARIAN D LALEVEE, MS RD CDE LDN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 ROUTE 28 PORT CENTRE BLDG., SUITE 2 G
HARWICH PORT MA
02646-1894
US

IV. Provider business mailing address

39 WONKAPIT WAY
CHATHAM MA
02633-1258
US

V. Phone/Fax

Practice location:
  • Phone: 508-945-3897
  • Fax: 508-945-1768
Mailing address:
  • Phone: 508-945-3897
  • Fax: 508-945-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number780
License Number StateMA

VIII. Authorized Official

Name: MARIAN D LALEVEE
Title or Position: PRESIDENT
Credential: MS RD CDE LDN LLC
Phone: 508-945-3897