Marybeth Reardon, M.S.,R.D., L.D.N

Primary specialty

NutritionistTaxonomy code 133N00000X

License

3553 Issued in MA

Practice address

92 Beethoven Ave
Waban, MA 02468-1746

Phone

(617) 916-0468

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1295950970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 PURITAN RD",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024611022",
            "telephone_number": "617-916-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 BEETHOVEN AVE",
            "city": "WABAN",
            "state": "MA",
            "postal_code": "024681746",
            "telephone_number": "617-916-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REARDON",
        "first_name": "MARYBETH",
        "name_prefix": "Mrs.",
        "credential": "M.S.,R.D., L.D.N",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "MA",
            "license": "3553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "KALIXHEALTH.COM",
            "affiliation": "N",
            "endpointDescription": "KALIXHEALTH.COM",
            "address_1": "92 Beethoven Ave",
            "city": "Waban",
            "state": "MA",
            "country_code": "US",
            "postal_code": "024681746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Nutritionist in Waban, MA
• Providers in Waban, MA by specialty
• Nutritionist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.