Provider Demographics
NPI:1770836124
Name:LOCONTE, MARA (RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:
Last Name:LOCONTE
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3840
Mailing Address - Country:US
Mailing Address - Phone:917-439-3180
Mailing Address - Fax:
Practice Address - Street 1:1412 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3840
Practice Address - Country:US
Practice Address - Phone:917-439-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007555133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered