Provider Demographics
NPI:1578734703
Name:SCHWARTZ, CAROLYN H (RD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:H
Last Name:SCHWARTZ
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 1:107 HUNNEWELL ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1809
Mailing Address - Country:US
Mailing Address - Phone:781-453-1219
Mailing Address - Fax:
Practice Address - Street 1:107 HUNNEWELL ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1809
Practice Address - Country:US
Practice Address - Phone:781-453-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2637133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered