Jessica Favazza Roberge, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1052 Issued in NH

Practice address

67 Corporate Dr Ste 300
Portsmouth, NH 03801-2847

Phone

(603) 610-8079

Fax

(603) 868-8375

NPI assigned

Feb 15, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jessica Grace Favazza Former name

Medicare fee-for-service enrollment

Enrolled in MA, NH2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wentworth Douglass Physician Corporation

  • Magnetic Resonance Imaging Radiologic Technologist
  • Dover, NH
  • NPI 1447352430

  Dietitian, Registered

  Medicare reassignment NPD
• Wentworth Douglass Physician Corporation

  • Diagnostic Radiology Physician
  • Somersworth, NH
  • NPI 1295326494
  NPD
• Wentworth Douglass Physician Corporation

  • Diabetes Educator Registered Nurse
  • Dover, NH
  • NPI 1336751825

  Dietitian, Registered

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1114510807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412503",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412503",
            "telephone_number": "603-610-8079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 CORPORATE DR STE 300",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038012847",
            "telephone_number": "603-610-8079",
            "fax_number": "603-868-8375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "276 Mechanic St",
            "address_purpose": "LOCATION",
            "city": "Laconia",
            "state": "NH",
            "postal_code": "032462539",
            "country_code": "US",
            "telephone_number": "603-770-6564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERGE",
        "first_name": "JESSICA",
        "middle_name": "FAVAZZA",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-15",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": "NH",
            "license": "1052",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NH",
            "license": "1052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "FAVAZZA",
            "middle_name": "GRACE",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marie Farah Riviere, MSW, LCSW, LICSW
• Magued Youssef Rizkalla Hanna, MD
• Robert Joseph Rizkalla Hanna, RPH
• Helen S. Rizza, HELEN RIZZA, ARNP
• Olivia Roach
• Dryden Lee Jarrell Robertson, OTR/L
• Marjorie Robinson-Henry
• Devyn Robinson
• Gerald Rocha, LCMHC
• Steffanie Rock

• Registered Dietitian in Portsmouth, NH
• Providers in Portsmouth, NH by specialty
• Registered Dietitian in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.