Provider Demographics
NPI:1093831141
Name:TEREO, ANTHONY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:TEREO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1215
Mailing Address - Country:US
Mailing Address - Phone:215-922-3040
Mailing Address - Fax:215-625-9632
Practice Address - Street 1:221 VINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1215
Practice Address - Country:US
Practice Address - Phone:215-922-3040
Practice Address - Fax:215-625-9632
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000394-1103TP0814X
VT098-0000066103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis