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General NPI Number Information
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NPI Number | 1982418893
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Entity Type | Individual
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Provider Name | LISA BOUSQUET RDN
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1952 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06517-1209
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Country | US
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Telephone | 203-848-1803
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Fax |
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Provider Business Mailing Address
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Address Line | 20 SCONSET LN
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City | GUILFORD
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State | CT
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Zip | 06437-1899
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Country | US
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Telephone | 860-510-2785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2808
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License Number State | CT
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