Provider Demographics
NPI:1306155809
Name:LABELLA, KATHLEEN S (RD, CD-N)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:LABELLA
Suffix:
Gender:F
Credentials: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 1:1 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1330
Mailing Address - Country:US
Mailing Address - Phone:860-767-1535
Mailing Address - Fax:860-767-1535
Practice Address - Street 1:1 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1330
Practice Address - Country:US
Practice Address - Phone:860-767-1535
Practice Address - Fax:860-767-1535
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000544133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic