Provider Demographics
NPI:1073685947
Name:KATZ, TERESE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESE
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CONZ ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3881
Mailing Address - Country:US
Mailing Address - Phone:413-586-5880
Mailing Address - Fax:413-584-2738
Practice Address - Street 1:90 CONZ ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3881
Practice Address - Country:US
Practice Address - Phone:413-586-5880
Practice Address - Fax:413-584-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA776600OtherTUFTS HEALTH PLAN
MAW50020OtherMEDICARE ID
MD1891103OtherMBHP
MD272844000OtherMAGELLAN BEHAVIORAL HEALT
MDW05548OtherBCBS
MA0596191Medicaid
MAW50020OtherMEDICARE ID
MAW50020Medicare PIN