Provider Demographics
NPI:1437764024
Name:STOCKER, CAROLYN ANNE (RD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANNE
Last Name:STOCKER
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 1:16 WHITIN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-2030
Mailing Address - Country:US
Mailing Address - Phone:413-896-4534
Mailing Address - Fax:
Practice Address - Street 1:16 WHITIN AVE
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2030
Practice Address - Country:US
Practice Address - Phone:413-896-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5151-NU-NU133V00000X, 133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered