Provider Demographics
NPI:1235341751
Name:DAVIDSON, DEBRA (RD, MS, CDE)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RD, MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2884
Mailing Address - Country:US
Mailing Address - Phone:978-686-0090
Mailing Address - Fax:978-681-5963
Practice Address - Street 1:34 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2884
Practice Address - Country:US
Practice Address - Phone:978-686-0090
Practice Address - Fax:978-681-5963
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4093133V00000X
NH0802136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered