Provider Demographics
NPI:1568562635
Name:CARR, JEAN M (RD)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
Last Name:CARR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:46 MEDFORD ST
Mailing Address - Street 2:#2
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2615
Mailing Address - Country:US
Mailing Address - Phone:617-889-0826
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE
Practice Address - Street 2:PRESTON 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2309
Practice Address - Country:US
Practice Address - Phone:618-638-5985
Practice Address - Fax:617-638-7449
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0097Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY