Provider Demographics
NPI:1396623757
Name:FERRITER, KELLY REBECCA (CLC, RDN, LDN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:REBECCA
Last Name:FERRITER
Suffix:
Gender:F
Credentials:CLC, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FENTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1028
Mailing Address - Country:US
Mailing Address - Phone:413-297-4829
Mailing Address - Fax:
Practice Address - Street 1:25 FENTON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1028
Practice Address - Country:US
Practice Address - Phone:413-297-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN7280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered