Provider Demographics
NPI:1003131780
Name:ALBERT-DEJESUS, THERESA RENEE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:RENEE
Last Name:ALBERT-DEJESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214A HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1444
Mailing Address - Country:US
Mailing Address - Phone:617-541-0454
Mailing Address - Fax:617-541-0454
Practice Address - Street 1:214A HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1444
Practice Address - Country:US
Practice Address - Phone:617-541-0454
Practice Address - Fax:617-541-0454
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor