Provider Demographics
NPI:1992509269
Name:LOCKHEAD, KELSEY (RD, LDN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:LOCKHEAD
Suffix:
Gender:
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2261
Mailing Address - Country:US
Mailing Address - Phone:781-996-9320
Mailing Address - Fax:
Practice Address - Street 1:400 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2261
Practice Address - Country:US
Practice Address - Phone:781-996-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA086447743133V00000X
MALDN7912133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered