Provider Demographics
NPI:1154628626
Name:ENERGY CENTER NUTRITION AND WEIGHT LOSS, LLC
Entity Type:Organization
Organization Name:ENERGY CENTER NUTRITION AND WEIGHT LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:YEMMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CPT
Authorized Official - Phone:617-276-7049
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:617-276-7049
Mailing Address - Fax:
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:SUITE 420
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:617-276-7049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty