Healthcare Provider Details

I. General information

NPI: 1265586838
Provider Name (Legal Business Name): DIANE R. DUBE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARADISE ROAD
SWAMPSCOTT MA
01907
US

IV. Provider business mailing address

PO BOX 8465
SALEM MA
01971-8465
US

V. Phone/Fax

Practice location:
  • Phone: 617-240-6383
  • Fax: 978-745-7982
Mailing address:
  • Phone: 617-240-6383
  • Fax: 978-745-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number748
License Number StateMA

VIII. Authorized Official

Name: MS. DIANE R DUBE
Title or Position: OWNER
Credential: RDN, LDN, CDECES
Phone: 617-240-6383