Active NPI
Leslie Anne Song, RD
- Pediatric Nutrition Registered Dietitian
- Worcester, MA
National Provider Identifier
1790961126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nutrition Registered Dietitian
- License
- 2685
- Practice address
- 55 Lake Ave N
Department of Nutrition and Food Services
Worcester, MA 01655-0002 - Phone
- (508) 334-4572
- NPI assigned
- Jan 16, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | 2685 | MA | Primary |
Addresses
Primary practice location
55 Lake Ave N
Department of Nutrition and Food Services
Worcester, MA 01655-0002
Mailing address
1600 Beacon St Apt 512
Brookline
Brookline, MA 02446-2226
Phone (617) 980-6056
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2685 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200441600000",
"number": "1790961126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 BEACON ST APT 512",
"address_2": "BROOKLINE",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462226",
"telephone_number": "617-980-6056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAKE AVE N",
"address_2": "DEPARTMENT OF NUTRITION AND FOOD SERVICES",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016550002",
"telephone_number": "508-334-4572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "LESLIE",
"middle_name": "ANNE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-16",
"last_updated": "2008-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "MA",
"license": "2685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.