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Contact Information

MIREILLE BLACKE, MA, RD, CD-N
6122 TOWN RDG
MIDDLETOWN, CT06457-6551
 Phone: 203-233-6680
 Fax: 860-852-3465
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Nutrition, Education

133NN1002X
Indicates primary specialty

NPI Profile & details for MIREILLE BLACKE · (Female)

NPI Number 1861768889
Status Active
Credentials MA, RD, CD-N
Entity Individual
Enumeration date 03/23/2012
Last updated 03/23/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • CT License # 001082
  • CT License # 1073878
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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