Organization
BEHAVIORAL NUTRITION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE TAVERAS MA, LMHC (CEO, BEHAVIORAL THERAPIST)
(617) 595-7044
Entity
Organization
Contact information
Practice address
1266 FURNACE BROOK PKWY, SUITE #404, QUINCY, MA 02169-4758
(617) 595-7044
Mailing address
1266 FURNACE BROOK PKWY, SUITE #404, QUINCY, MA 02169-4758
(617) 595-7044
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
3632
MA
133V00000X
Registered Dietitian
Primary
86013220
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851686455
BEHAVIORAL NUTRITION
MA
Enumeration date
04/24/2014
Last updated
04/24/2014
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