Provider Demographics
NPI:1043096209
Name:LICATA, ERIN NICOLE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:LICATA
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WOODCHUCK LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-5726
Mailing Address - Country:US
Mailing Address - Phone:831-359-1474
Mailing Address - Fax:
Practice Address - Street 1:39 WOODCHUCK LN
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-5726
Practice Address - Country:US
Practice Address - Phone:831-359-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty