Provider Demographics
NPI:1053689729
Name:SMITH, JULIE KATHERINE (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KATHERINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-0009
Mailing Address - Country:US
Mailing Address - Phone:617-410-6396
Mailing Address - Fax:
Practice Address - Street 1:31A JACKSON STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-410-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered