Basic Information
| Provider Information | |||||||||
| NPI: | 1144695057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAZZARO | ||||||||
| FirstName: | ALICIA | ||||||||
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| Credential: | MS RD LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 HERRICK ST | ||||||||
| Address2: | BEVERLY HOSPITAL, DIETITIAN OFFICE/FOOD&NUTRITION DEPT | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019151790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789223000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 HERRICK ST | ||||||||
| Address2: | BEVERLY HOSPITAL, DIETITIAN OFFICE/FOOD&NUTRITION DEPT | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019151790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789223000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2015 | ||||||||
| LastUpdateDate: | 12/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 2855 | MA | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | 2855 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.