Individual
MS. TINA BOUCHER REILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
1200 CENTRE ST, ROSLINDALE, MA 02131-1011
(617) 363-8241
Mailing address
1200 CENTRE ST, ROSLINDALE, MA 02131-1011
(617) 363-8241
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
621
MA
133V00000X
Registered Dietitian
710263
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
621
BOARD OF REGISTRATION OF DIETITIANS AND NUTRITIONISTS
MA
01
—
710263
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
12/15/2021
Last updated
12/15/2021
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