Provider Demographics
NPI:1386735702
Name:SMITH, LYNNE J (MS RD LDN)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:
Other - Last Name:JARRET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1145 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2143
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:412-693-1012
Practice Address - Street 1:532 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2458
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-737-1643
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA87133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA37304OtherHEALTH NEW ENGLAND
MA87OtherLICENSE
MA863926OtherREGISTERED DIETICIAN #
MAMT0789Medicare ID - Type Unspecified
MAM21172Medicare PIN