Provider Demographics
NPI:1790138345
Name:RICHARD, ELIZABETH SORENSON (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SORENSON
Last Name:RICHARD
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 1:26 MIDDLEBURY LN
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1300
Mailing Address - Country:US
Mailing Address - Phone:617-935-6872
Mailing Address - Fax:
Practice Address - Street 1:26 MIDDLEBURY LN
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1300
Practice Address - Country:US
Practice Address - Phone:617-935-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4054133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered