Provider Demographics
NPI:1205148020
Name:BAILLARGEON, CASSIE (RD)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:
Last Name:BAILLARGEON
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 1:3047 NYS ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NY
Mailing Address - Zip Code:12942-2310
Mailing Address - Country:US
Mailing Address - Phone:518-524-2729
Mailing Address - Fax:
Practice Address - Street 1:3047 NYS ROUTE 73
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NY
Practice Address - Zip Code:12942-2310
Practice Address - Country:US
Practice Address - Phone:518-873-3577
Practice Address - Fax:518-873-6764
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00973042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered