Provider Demographics
NPI:1396824793
Name:PROIETTA, MARY CATHERINE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:PROIETTA
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 1:53 WAPPING DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-4906
Mailing Address - Country:US
Mailing Address - Phone:401-254-0984
Mailing Address - Fax:401-254-0984
Practice Address - Street 1:610 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2427
Practice Address - Country:US
Practice Address - Phone:401-435-7800
Practice Address - Fax:401-254-0984
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00224133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI404237OtherBLUE CHIP
RI6300054OtherUNITED HEALTH CARE
RI7632-2OtherBLUE CROSS
RI7632-2OtherBLUE CROSS