Clinical Weight Loss & Wellness LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

CLINICAL WEIGHT LOSS & WELLNESS LLC

Practice address

2790 Main St
Glastonbury, CT 06033-2027

Phone

(860) 430-9922

Fax

(860) 633-9922

NPI assigned

Mar 11, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Jeannie Marie Leitao, RD, CDE, CDNNPI 1598094963

Title

Owner/Ceo

Phone

(860) 430-9922

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeannie Marie Leitao, RD

  • Registered Dietitian
  • Glastonbury, CT
  • NPI 1598094963

  Dietitian, Registered

  Medicare reassignment NPD Authorized official
• Sydney Kendall Spiewak, REGISTERED DIETITIAN

  • Registered Dietitian
  • Glastonbury, CT
  • NPI 1306432638

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1265990030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 MAIN ST",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332027",
            "telephone_number": "860-430-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 MAIN ST",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332027",
            "telephone_number": "860-430-9922",
            "fax_number": "860-633-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL WEIGHT LOSS & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-11",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "LEITAO",
        "authorized_official_first_name": "JEANNIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "860-430-9922",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RD, CDE, CDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Caroline Ciardella
• Heather Marie Cios, FNP
• Donna M Cipolla, MD
• Raymund Claudio Jr.
• Clinical Couch of Connecticut LLC
• Amy Close, APRN
• CMC Psychological Associates, LLC
• Andrea Coakley
• Jason Miles Cobb, MS, ATC/L
• Jeffrey A Cohan, DMD

• Registered Dietitian in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Registered Dietitian in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; 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.