Provider Demographics
NPI:1750717302
Name:BONETTI, REBECCA (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BONETTI
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 BUCKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2473
Mailing Address - Country:US
Mailing Address - Phone:203-578-5211
Mailing Address - Fax:
Practice Address - Street 1:500 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3530
Practice Address - Country:US
Practice Address - Phone:203-671-3392
Practice Address - Fax:888-855-7803
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1202133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered