Provider Demographics
NPI:1699057836
Name:STROMBERG, KARA (RD)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:STROMBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:85 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2016
Mailing Address - Country:US
Mailing Address - Phone:860-224-3642
Mailing Address - Fax:860-224-2760
Practice Address - Street 1:85 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2016
Practice Address - Country:US
Practice Address - Phone:860-224-3642
Practice Address - Fax:860-224-2760
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001055133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid