Provider Demographics
NPI:1609296110
Name:MARINAKIS, NICHOLAS SMITH (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SMITH
Last Name:MARINAKIS
Suffix:
Gender:M
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WOBURN ST STE 13
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2973
Mailing Address - Country:US
Mailing Address - Phone:978-276-4770
Mailing Address - Fax:
Practice Address - Street 1:36 WOBURN ST STE 13
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2973
Practice Address - Country:US
Practice Address - Phone:978-276-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA5370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101Y00000XBehavioral Health & Social Service ProvidersCounselor