Provider Demographics
NPI:1427568567
Name:GRAHAM, JOCELYN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:BRAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:414 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1919
Mailing Address - Country:US
Mailing Address - Phone:603-801-8776
Mailing Address - Fax:
Practice Address - Street 1:414 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969
Practice Address - Country:US
Practice Address - Phone:877-379-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4353133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4353OtherLICENSED DIETITIAN / NUTRITIONIST
MA86027928OtherREGISTERED DIETITIAN NUTRITIONIST