Theresa M Moutafis, RD, LDN, CDE, IBCLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

000003134 Issued in MA

Practice address

62 Appleton St
Salem, MA 01970-1630

Phone

(315) 730-1858

NPI assigned

Apr 11, 2011

Last updated

Dec 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Theresa M Camardo Former name

Medicare fee-for-service enrollment

Enrolled in MA, NY2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Zipongo Health Provider Group P.a.

  dba Foodsmart Nutrition Network

  • Obesity and Weight Management Nutrition Registered Dietitian
  • San Francisco, CA
  • NPI 1972146694

  MA, NY

  Medicare reassignment NPD
• Aeroflow Connect LLC

  dba Lactation Link

  • Lactation Consultant (Non-RN)
  • Asheville, NC
  • NPI 1790306819

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1588954622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 APPLETON ST",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019701630",
            "telephone_number": "315-730-1858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 APPLETON ST",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019701630",
            "telephone_number": "315-730-1858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUTAFIS",
        "first_name": "THERESA",
        "middle_name": "M",
        "credential": "RD, LDN, CDE, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-11",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "1009944",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "000003134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "CAMARDO",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christina Morris
• Julia Moskowitz, PSYD
• Mother Teresa of Salem LLC
• Khalil Mouchantaf, MD
• Jon S Moussally, M.D.
• Movemore Performance Health, LLC
• MSR Home Care (FirstLight HomeCare of Salem)
• Jennifer Mueller
• Usman Mughal, MD
• Jennifer Mulcahy-Avery

• Registered Dietitian in Salem, MA
• Providers in Salem, MA by specialty
• Registered Dietitian in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.