Provider Demographics
NPI:1801547963
Name:LITWAK, JAQUELYN (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JAQUELYN
Middle Name:
Last Name:LITWAK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WORCESTER RD APT 7619A
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8964
Mailing Address - Country:US
Mailing Address - Phone:508-735-0057
Mailing Address - Fax:
Practice Address - Street 1:1400 WORCESTER RD APT 7619A
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8964
Practice Address - Country:US
Practice Address - Phone:508-735-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86107830133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered