Provider Demographics
NPI:1164524575
Name:PETITTO, COLLEEN MALENA (RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MALENA
Last Name:PETITTO
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MICHELE
Other - Last Name:MALENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:17 ARENTZEN BLVD
Mailing Address - Street 2:VISTA ONE PROFESSIONAL CENTER SUITE 105
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-1085
Mailing Address - Country:US
Mailing Address - Phone:724-489-0850
Mailing Address - Fax:
Practice Address - Street 1:17 ARENTZEN BLVD
Practice Address - Street 2:VISTA ONE PROFESSIONAL CENTER SUITE 105
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1085
Practice Address - Country:US
Practice Address - Phone:724-489-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN 001238133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered