Provider Demographics
NPI:1639806151
Name:CARROLL, EILEEN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:CARROLL
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 1:356 1/2 CABOT ST # A2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3345
Mailing Address - Country:US
Mailing Address - Phone:978-828-2911
Mailing Address - Fax:
Practice Address - Street 1:356 1/2 CABOT ST # A2
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3345
Practice Address - Country:US
Practice Address - Phone:978-828-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2732133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty