Provider Demographics
NPI:1326165580
Name:FREDENBURG, MARCIE LEE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:LEE
Last Name:FREDENBURG
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:LANESBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01237-1536
Mailing Address - Country:US
Mailing Address - Phone:413-445-5949
Mailing Address - Fax:
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:413-447-2605
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered