Healthcare Provider Details

I. General information

NPI: 1366601098
Provider Name (Legal Business Name): CATHERINE H CRICCO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 FREEMAN RD
PLAINFIELD NH
03781-5019
US

IV. Provider business mailing address

364 FREEMAN RD
PLAINFIELD NH
03781-5019
US

V. Phone/Fax

Practice location:
  • Phone: 603-675-5708
  • Fax: 603-543-1323
Mailing address:
  • Phone: 603-675-5708
  • Fax: 603-543-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number618193
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: