Provider Demographics
NPI:1053920223
Name:DICHIARA, KATHLEEN (FDN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DICHIARA
Suffix:
Gender:F
Credentials:FDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-1717
Mailing Address - Country:US
Mailing Address - Phone:401-400-0930
Mailing Address - Fax:
Practice Address - Street 1:5 PRINCESS PINE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4729
Practice Address - Country:US
Practice Address - Phone:401-654-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist