Provider Demographics
NPI:1174030027
Name:PUPUTTI, MARISSA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:PUPUTTI
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 RINDGE RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-1323
Mailing Address - Country:US
Mailing Address - Phone:508-331-7444
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORATION WAY STE 260
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7932
Practice Address - Country:US
Practice Address - Phone:978-531-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-01
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4297133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered