Provider Demographics
NPI:1093040073
Name:BECKER, TOBIE SUSAN (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:TOBIE
Middle Name:SUSAN
Last Name:BECKER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WAYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3622
Mailing Address - Country:US
Mailing Address - Phone:508-366-9144
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-754-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1740133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered