Provider Demographics
NPI:1376082479
Name:CARROLL, BRIDGITTE (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:BRIDGITTE
Middle Name:
Last Name:CARROLL
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 1:342 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1843
Mailing Address - Country:US
Mailing Address - Phone:419-320-8687
Mailing Address - Fax:
Practice Address - Street 1:342 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1843
Practice Address - Country:US
Practice Address - Phone:419-320-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00887133V00000X
MA4165133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered