Individual
MIREILLE BLACKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, RD, CD-N
Contact information
Practice address
6122 TOWN RDG, MIDDLETOWN, CT 06457-6551
(203) 233-6680
(860) 852-3465
Mailing address
6122 TOWN RDG, MIDDLETOWN, CT 06457-6551
(203) 233-6680
(860) 852-3465
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
001082
CT
133V00000X
Registered Dietitian
Primary
1073878
CT
Other
Enumeration date
03/23/2012
Last updated
03/23/2012
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