Provider Demographics
NPI:1871798090
Name:KIARIE, CAITLIN SULLIVAN (RDN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SULLIVAN
Last Name:KIARIE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1909
Mailing Address - Country:US
Mailing Address - Phone:619-948-8815
Mailing Address - Fax:
Practice Address - Street 1:45 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1909
Practice Address - Country:US
Practice Address - Phone:973-932-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ985191133V00000X
133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal