Provider Demographics
NPI:1902114119
Name:CRISAFULLI, BETSY FISHER (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:FISHER
Last Name:CRISAFULLI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MISS
Other - First Name:BETSY
Other - Middle Name:KATHERINE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2772
Practice Address - Fax:202-955-5541
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000962133V00000X
VA133V00000X
DCDI200001461133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000962OtherCERTIFIED DIETITIAN/NUTRITIONIST