Provider Demographics
NPI:1902507734
Name:CASS, OLIVIA (RDN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:CASS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREAT LAKE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2341
Mailing Address - Country:US
Mailing Address - Phone:862-268-2507
Mailing Address - Fax:
Practice Address - Street 1:15 GREAT LAKE LN
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2341
Practice Address - Country:US
Practice Address - Phone:862-268-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6747133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered