Provider Demographics
NPI:1730230202
Name:SCARLATA, KATHRYN MEGAN (KATE SCARLATA)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MEGAN
Last Name:SCARLATA
Suffix:
Gender:F
Credentials:KATE SCARLATA
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:MEGAN
Other - Last Name:SCARLATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KATE SCARLATA
Mailing Address - Street 1:11 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1113
Mailing Address - Country:US
Mailing Address - Phone:508-533-3190
Mailing Address - Fax:
Practice Address - Street 1:1832 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1901
Practice Address - Country:US
Practice Address - Phone:508-740-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1288133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA39440OtherHARVARD PILGRIM
MALD0103OtherBLUE CROSS BLUE SHIELD
MA799235OtherTUFTS HEALTH PLAN
MALDN1288OtherMASS. LICENSE
MALDN1288OtherMASS. LICENSE