Provider Demographics
NPI:1487820080
Name:BEBO, PATRICIA ANN (MS,RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:BEBO
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 RUTLAND SQ
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6825
Mailing Address - Country:US
Mailing Address - Phone:508-846-9554
Mailing Address - Fax:508-675-7467
Practice Address - Street 1:54 RUTLAND SQ
Practice Address - Street 2:SUITE 2
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6825
Practice Address - Country:US
Practice Address - Phone:508-846-9554
Practice Address - Fax:508-675-7467
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered