Provider Demographics
NPI:1417369281
Name:LEBOVITZ, ARIELLE DANI (RD, CDE, CSSD)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:DANI
Last Name:LEBOVITZ
Suffix:
Gender:F
Credentials:RD, CDE, CSSD
Other - Prefix:
Other - First Name:ARIELLE
Other - Middle Name:DANI
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 7TH ST BLDG 700700-A
Mailing Address - Street 2:78 AMDS/SPGZ
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:478-222-6904
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST BLDG 700700-A
Practice Address - Street 2:78 AMDS/SPGZ
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-222-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered