Provider Demographics
NPI:1518474477
Name:VAN DUSEN, LEIGH PATRICIA (MS, LDN)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:PATRICIA
Last Name:VAN DUSEN
Suffix:
Gender:F
Credentials:MS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 HIGHLAND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2606
Mailing Address - Country:US
Mailing Address - Phone:646-369-2255
Mailing Address - Fax:
Practice Address - Street 1:1492 HIGHLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2606
Practice Address - Country:US
Practice Address - Phone:646-369-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3284133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist