Provider Demographics
NPI:1043843386
Name:DOE, TESSA LEIGH
Entity Type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:LEIGH
Last Name:DOE
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 1:7 WHITES MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2141
Mailing Address - Country:US
Mailing Address - Phone:978-821-0088
Mailing Address - Fax:
Practice Address - Street 1:229 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2705
Practice Address - Country:US
Practice Address - Phone:978-441-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100021990195OtherMASSHEALTH