Healthcare Provider Details

I. General information

NPI: 1396824793
Provider Name (Legal Business Name): MARY CATHERINE PROIETTA R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WATERMAN AVE
EAST PROVIDENCE RI
02914-2427
US

IV. Provider business mailing address

53 WAPPING DR
BRISTOL RI
02809-4906
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-7800
  • Fax: 401-254-0984
Mailing address:
  • Phone: 401-254-0984
  • Fax: 401-254-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00224
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: