Provider Demographics
NPI:1124124359
Name:LAREDO, ROBERTA DALE (RD, LDN, CDE)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:DALE
Last Name:LAREDO
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PHILMORE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2719
Mailing Address - Country:US
Mailing Address - Phone:617-527-9889
Mailing Address - Fax:617-795-0893
Practice Address - Street 1:93 UNION ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2244
Practice Address - Country:US
Practice Address - Phone:617-332-4233
Practice Address - Fax:617-332-8233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0128Medicare ID - Type Unspecified