Individual
LORI ANN DECOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD CNSC
Contact information
Practice address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-2588
Mailing address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-2588
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2415
MA
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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