Provider Demographics
NPI:1033660972
Name:SAMUELS, EMILY (MS RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RD
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 4W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-680-3888
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:SUITE 4W
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-680-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3054133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered