Provider Demographics
NPI:1740625250
Name:HADDAD, JEANNED'ARC (RD)
Entity type:Individual
Prefix:
First Name:JEANNED'ARC
Middle Name:
Last Name:HADDAD
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 1:170 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5506
Mailing Address - Country:US
Mailing Address - Phone:781-232-5433
Mailing Address - Fax:781-431-1933
Practice Address - Street 1:170 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5506
Practice Address - Country:US
Practice Address - Phone:781-232-5433
Practice Address - Fax:781-431-1933
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered