Sidewater, Debra R
Sidewater, Debra R is an individual health care provider with primary practice located at 555 Willard Ave Nutrition Clinic, Second Floor, Newington CT 06111-2631. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Dietary & Nutritional Service Providers / Dietitian, Registered. Behavioral Health & Social Service Providers / Social Worker is her primary health care specialty. Sidewater, Debra R can be contacted via phone (860) 667-6797.Contact Information
Primary practice address
555 Willard Ave Nutrition Clinic, Second Floor
Newington CT 06111-2631
Phone: (860) 667-6797
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | ||
| Dietary & Nutritional Service Providers / Dietitian, Registered | 133V00000X | 000128 | Connecticut |
Profile Details
| NPI number | 1174621064 |
|---|---|
| LBN Legal business name | Sidewater, Debra R |
| Credentials | R.D.,M.S.W. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 21st, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174621064 | NPPES |
| Other | R464768 | REGISTERED DIETITIAN | |
| Other | 1027 | REGISTERED DIETITIAN | |
| Other | 000128 | REGISTERED DIETITIAN |
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