Provider Demographics
NPI:1174210744
Name:SEELEY, JENNIFER L (MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SEELEY
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PITMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CNS, LDN
Mailing Address - Street 1:100 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1021
Mailing Address - Country:US
Mailing Address - Phone:310-663-1925
Mailing Address - Fax:
Practice Address - Street 1:100 PINE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1021
Practice Address - Country:US
Practice Address - Phone:310-663-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6691133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education