Provider Demographics
NPI:1871698415
Name:GALLICHOTTE, CHRISTINE E (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:GALLICHOTTE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FEDERAL RD
Mailing Address - Street 2:UNIT C33B
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2647
Mailing Address - Country:US
Mailing Address - Phone:203-775-3536
Mailing Address - Fax:203-740-2725
Practice Address - Street 1:246 FEDERAL RD
Practice Address - Street 2:UNIT C33B
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2647
Practice Address - Country:US
Practice Address - Phone:203-775-3536
Practice Address - Fax:203-740-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000121133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2456991OtherAETNA HMO
CT4546925OtherAETNA
CTP470799OtherOXFORD HEALTH PLANS
CT270000121CT01OtherANTHEM BLUE CROSS BLUE SH