Provider Demographics
NPI:1811401722
Name:GREAVES, JILLIAN MARIE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARIE
Last Name:GREAVES
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 UPHAM AVE # 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2001
Mailing Address - Country:US
Mailing Address - Phone:617-803-0808
Mailing Address - Fax:
Practice Address - Street 1:665 BOYLSTON ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4824
Practice Address - Country:US
Practice Address - Phone:857-244-0162
Practice Address - Fax:617-507-6172
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4303133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered