Provider Demographics
NPI:1417665605
Name:MARTINO, JESSICA LEE (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2525
Mailing Address - Country:US
Mailing Address - Phone:617-605-5187
Mailing Address - Fax:
Practice Address - Street 1:32 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2525
Practice Address - Country:US
Practice Address - Phone:617-605-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5506-NU-NUOtherCOMMONWEALTH OF MASSACHUSETTS
86117635OtherCOMMISSION ON DIETETIC REGISTRATION