Provider Demographics
NPI:1871672063
Name:DIPIETRO, KAREN S (RD, CDE)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BRICKETT AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6504
Mailing Address - Country:US
Mailing Address - Phone:978-374-2050
Mailing Address - Fax:
Practice Address - Street 1:215 SUMMER ST
Practice Address - Street 2:SUITE 8
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6320
Practice Address - Country:US
Practice Address - Phone:978-373-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN1777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALDN1777OtherSTATE LICENSURE
MA70010000LD0157OtherBLUE CROSS BLUE SHIELD
NH22OtherLICENSED DIETITIAN
MA70010000LD0157OtherBLUE CROSS BLUE SHIELD