Provider Demographics
NPI:1083683536
Name:O'BRIEN, CATHERINE A (RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:O'BRIEN
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 1:541 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-331-7799
Mailing Address - Fax:781-331-9515
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-331-7799
Practice Address - Fax:781-331-9515
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0122OtherBLUE CROSS BLUE SHIELD
MALD0122OtherBLUE CROSS BLUE SHIELD