Provider Demographics
NPI:1588191225
Name:DECARIA, RACHAEL (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:DECARIA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 KANAWHA DR
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3916
Mailing Address - Country:US
Mailing Address - Phone:304-894-6083
Mailing Address - Fax:
Practice Address - Street 1:184 KANAWHA DR
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3916
Practice Address - Country:US
Practice Address - Phone:304-894-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005076133V00000X
WV1062133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered