Provider Demographics
NPI:1003426594
Name:SOCHA, MOLLIE ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:ELIZABETH
Last Name:SOCHA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COONEY RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1405
Mailing Address - Country:US
Mailing Address - Phone:508-335-3873
Mailing Address - Fax:
Practice Address - Street 1:33 COONEY RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1405
Practice Address - Country:US
Practice Address - Phone:508-335-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered