Individual
SUSAN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
360 W BOYLSTON ST RM 107, WEST BOYLSTON, MA 01583-2370
(508) 854-1380
(508) 854-1380
Mailing address
372 MERIDIAN ST, BOSTON, MA 02128-5123
(617) 398-7752
(857) 264-5086
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
217
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA51160
HARVARD PILGRIM
MA
01
—
LD0181
BCBS OF MA
MA
Enumeration date
12/27/2006
Last updated
12/27/2023
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