Provider Demographics
NPI:1326878935
Name:WHITE, CASIE MARCUS (RD, CSCS)
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:MARCUS
Last Name:WHITE
Suffix:
Gender:M
Credentials:RD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RIVER POINTE WAY APT 2306
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3843
Mailing Address - Country:US
Mailing Address - Phone:585-269-9518
Mailing Address - Fax:
Practice Address - Street 1:121 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3104
Practice Address - Country:US
Practice Address - Phone:781-462-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH133V00000X
MA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered