Provider Demographics
NPI:1295933356
Name:KRIEG, DEBORAH L (RD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:KRIEG
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 1:4199 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1733
Mailing Address - Country:US
Mailing Address - Phone:617-323-4440
Mailing Address - Fax:617-323-7870
Practice Address - Street 1:4199 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1733
Practice Address - Country:US
Practice Address - Phone:617-323-4440
Practice Address - Fax:617-323-7870
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2594133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered