Provider Demographics
NPI:1477971323
Name:LAROCK, MICHELE (MS RDN LDN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LAROCK
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01038-9716
Mailing Address - Country:US
Mailing Address - Phone:413-570-3281
Mailing Address - Fax:
Practice Address - Street 1:17 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2788
Practice Address - Country:US
Practice Address - Phone:413-570-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered