Individual
THERESA M MOUTAFIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN, CDE, IBCLC
Contact information
Practice address
62 APPLETON ST, SALEM, MA 01970-1630
(315) 730-1858
Mailing address
62 APPLETON ST, SALEM, MA 01970-1630
(315) 730-1858
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000003134
MA
133V00000X
Registered Dietitian
1009944
—
133V00000X
Registered Dietitian
—
NY
Other
Enumeration date
04/11/2011
Last updated
12/18/2019
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