Healthcare Provider Details

I. General information

NPI: 1225379332
Provider Name (Legal Business Name): JENNIFER T DIBELLO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST SUITE 11-A
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

PO BOX 3238
BOSTON MA
02241-3238
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-8770
  • Fax: 401-793-8709
Mailing address:
  • Phone: 866-334-2455
  • Fax: 888-614-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00533
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: