Provider Demographics
NPI:1831330752
Name:PICI, JEANNE SUSAN (MS, RD, CD-N)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:SUSAN
Last Name:PICI
Suffix:
Gender:F
Credentials:MS, RD, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MIDBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1428
Mailing Address - Country:US
Mailing Address - Phone:203-637-9163
Mailing Address - Fax:
Practice Address - Street 1:6 MIDBROOK LN
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1428
Practice Address - Country:US
Practice Address - Phone:203-637-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000005133V00000X
NY000706-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered