Provider Demographics
NPI:1114236114
Name:RODOWICZ, MARY O'BRIEN (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:O'BRIEN
Last Name:RODOWICZ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:HELEN
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:421 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9764
Mailing Address - Country:US
Mailing Address - Phone:413-582-3005
Mailing Address - Fax:413-582-3121
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9764
Practice Address - Country:US
Practice Address - Phone:413-582-3005
Practice Address - Fax:413-582-3121
Is Sole Proprietor?:No
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered