Provider Demographics
NPI:1134998065
Name:MCCABE, MOLLY JULIA (RD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:JULIA
Last Name:MCCABE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4452
Mailing Address - Country:US
Mailing Address - Phone:802-355-6677
Mailing Address - Fax:
Practice Address - Street 1:142 W TWIN OAKS TER
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7132
Practice Address - Country:US
Practice Address - Phone:802-355-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134481133V00000X
IN37004083A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered