Provider Demographics
NPI:1366780892
Name:KAREN DECKER, MS, RD, LDN
Entity type:Organization
Organization Name:KAREN DECKER, MS, RD, LDN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:805-443-1033
Mailing Address - Street 1:8 GROVE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7797
Mailing Address - Country:US
Mailing Address - Phone:805-443-1033
Mailing Address - Fax:781-237-9037
Practice Address - Street 1:8 GROVE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7797
Practice Address - Country:US
Practice Address - Phone:805-443-1033
Practice Address - Fax:781-237-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3346133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty