Provider Demographics
NPI:1538254321
Name:GOLDBERG, MARY KATHERINE (RD, MPG, LDN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:RD, MPG, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1729
Mailing Address - Country:US
Mailing Address - Phone:508-252-4766
Mailing Address - Fax:
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:DEPT. FOOD AND NUTRITION
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-961-5160
Practice Address - Fax:508-961-5158
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU1381133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANU1381OtherPROFESSIONAL LICENSURE