Provider Demographics
NPI:1063823839
Name:OUELLETTE, THERESA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 NAEK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3965
Mailing Address - Country:US
Mailing Address - Phone:860-982-9825
Mailing Address - Fax:860-870-9384
Practice Address - Street 1:27 NAEK RD STE 4
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3965
Practice Address - Country:US
Practice Address - Phone:860-982-9825
Practice Address - Fax:860-870-9384
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health