Healthcare Provider Details

I. General information

NPI: 1083683536
Provider Name (Legal Business Name): CATHERINE A. O'BRIEN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 MAIN ST SUITE 400
SOUTH WEYMOUTH MA
02190-1868
US

IV. Provider business mailing address

541 MAIN ST SUITE 400
SOUTH WEYMOUTH MA
02190-1868
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-7799
  • Fax: 781-331-9515
Mailing address:
  • Phone: 781-331-7799
  • Fax: 781-331-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1207
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: