Provider Demographics
NPI:1144506262
Name:BEERS, JACINTA REGINA (RD)
Entity type:Individual
Prefix:
First Name:JACINTA
Middle Name:REGINA
Last Name:BEERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JACINTA
Other - Middle Name:REGINA
Other - Last Name:HABERSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 LANDRAKE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-1824
Mailing Address - Country:US
Mailing Address - Phone:410-337-0979
Mailing Address - Fax:
Practice Address - Street 1:1818 LANDRAKE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-1824
Practice Address - Country:US
Practice Address - Phone:410-337-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered