Individual
DEBRA R SIDEWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.,M.S.W.
Contact information
Practice address
555 WILLARD AVE, NUTRITION CLINIC, SECOND FLOOR, NEWINGTON, CT 06111-2631
(860) 667-6797
Mailing address
21 VANDERVERE RD, WEST HARTFORD, CT 06117-2745
(860) 232-0780
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
133V00000X
Registered Dietitian
000128
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000128
CERTIFIED DIETITIAN
CT
01
—
1027
CERTIFIED DIABETES EDUCAT
—
01
—
R464768
REGISTERED DIETITIAN
—
Enumeration date
09/21/2006
Last updated
09/11/2025
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