Provider Demographics
NPI:1003248311
Name:FAIRFIELD COUNTY LIFESTYLE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY LIFESTYLE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE, CD-N
Authorized Official - Phone:203-256-0048
Mailing Address - Street 1:1305 POST RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-256-0048
Mailing Address - Fax:203-256-0049
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:SUITE 307
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-256-0048
Practice Address - Fax:203-256-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710000150Medicare PIN