Provider Demographics
NPI:1598513723
Name:MANISCALCO, LAUREN HELEN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:HELEN
Last Name:MANISCALCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COURTHOUSE LN STE 10
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1723
Mailing Address - Country:US
Mailing Address - Phone:978-332-6893
Mailing Address - Fax:
Practice Address - Street 1:2 COURTHOUSE LN STE 10
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1723
Practice Address - Country:US
Practice Address - Phone:978-332-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86173724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered