Provider Demographics
NPI:1972621514
Name:BRAINERD, MARGUERITE GARCIA (RD, CDE, CD-N)
Entity type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:GARCIA
Last Name:BRAINERD
Suffix:
Gender:F
Credentials:RD, CDE, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3931
Mailing Address - Country:US
Mailing Address - Phone:860-426-0101
Mailing Address - Fax:
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-7566
Practice Address - Fax:203-573-7166
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT896356133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered