Provider Demographics
NPI:1881723955
Name:LOVE, LORRAINE (RD, LD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1325
Mailing Address - Country:US
Mailing Address - Phone:978-456-8053
Mailing Address - Fax:978-456-8053
Practice Address - Street 1:42 THOREAU ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2411
Practice Address - Country:US
Practice Address - Phone:978-456-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA712215OtherTUFTS PROVIDER NUMBER
MA39251OtherHPHC PROVIDER NUMBER
MALD 0057OtherBLUE CROSS PROVIDER NUMBE
MA712215OtherTUFTS PROVIDER NUMBER