Provider Demographics
NPI:1376971465
Name:MARESCIA, CHRISTINA (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARESCIA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CUMBERLAND AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2646
Mailing Address - Country:US
Mailing Address - Phone:603-548-2239
Mailing Address - Fax:
Practice Address - Street 1:80 PALOMINO LN
Practice Address - Street 2:SUITE 101
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6447
Practice Address - Country:US
Practice Address - Phone:603-315-7936
Practice Address - Fax:888-719-5991
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered