Healthcare Provider Details

I. General information

NPI: 1013551050
Provider Name (Legal Business Name): CATHERINE MACLAUGHLIN BRENNAN RDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE MACLAUGHLIN BRENNAN RDN, CLC

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 NARRAGANSETT AVE
JAMESTOWN RI
02835-1169
US

IV. Provider business mailing address

238 NARRAGANSETT AVE
JAMESTOWN RI
02835
US

V. Phone/Fax

Practice location:
  • Phone: 401-442-7258
  • Fax:
Mailing address:
  • Phone: 401-442-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLDN00968
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: