Mireille Blacke, MA, RD, CD-N

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1073878 Issued in CT

Practice address

6122 Town RDG
Middletown, CT 06457-6551

Phone

(203) 233-6680

Fax

(860) 852-3465

NPI assigned

Mar 23, 2012

Last updated

Mar 23, 2012By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1861768889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6122 TOWN RDG",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064576551",
            "telephone_number": "203-233-6680",
            "fax_number": "860-852-3465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6122 TOWN RDG",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064576551",
            "telephone_number": "203-233-6680",
            "fax_number": "860-852-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKE",
        "first_name": "MIREILLE",
        "credential": "MA, RD, CD-N",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-23",
        "last_updated": "2012-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "CT",
            "license": "001082",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "1073878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne S Bingham
• Brittany Leigh Bingham, BCBA
• Jamie Lynn Birchall, AS DARC
• Kenneth I Bird, MD
• Todd M Bishop, DO
• Marissa Blake
• Jennifer A Blakeslee, LCSW
• Alec G Blakey, LCSW
• Jonathan D Blancaflor, MD
• Rosemary Bleyer, PH.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.