Provider Demographics
NPI:1831573880
Name:GUSTAMACHIO, CATHERINE (RD, LDN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GUSTAMACHIO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GUSTAMACHIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:965 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4685
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:965 CONCORD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4685
Practice Address - Country:US
Practice Address - Phone:508-237-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3343133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered