Provider Demographics
NPI:1952847600
Name:JOY MCCALLUM, MS, RDN, LDN, CLT
Entity Type:Organization
Organization Name:JOY MCCALLUM, MS, RDN, LDN, CLT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:781-861-0762
Mailing Address - Street 1:22 FAIRBANKS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7729
Mailing Address - Country:US
Mailing Address - Phone:781-861-0762
Mailing Address - Fax:
Practice Address - Street 1:22 FAIRBANKS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7729
Practice Address - Country:US
Practice Address - Phone:781-861-0762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU 209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty