Provider Demographics
NPI:1821869058
Name:KITZIS, BETH (RDN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:KITZIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2627
Mailing Address - Country:US
Mailing Address - Phone:617-803-1925
Mailing Address - Fax:
Practice Address - Street 1:82 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2627
Practice Address - Country:US
Practice Address - Phone:617-803-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN4454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered