Provider Demographics
NPI:1851811426
Name:MORRISSEY, MARY (RDN, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:RDN, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 SHERATON LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1613
Mailing Address - Country:US
Mailing Address - Phone:513-604-1004
Mailing Address - Fax:513-604-1005
Practice Address - Street 1:12103 SHERATON LN
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-1613
Practice Address - Country:US
Practice Address - Phone:513-604-1004
Practice Address - Fax:513-604-1005
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1640133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered