Provider Demographics
NPI:1417621780
Name:ALLEN, TERESA ANN (PMHNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-5105
Mailing Address - Country:US
Mailing Address - Phone:508-663-3809
Mailing Address - Fax:513-440-8404
Practice Address - Street 1:340 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-5105
Practice Address - Country:US
Practice Address - Phone:508-663-3809
Practice Address - Fax:513-440-8404
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236745163WP0809X
MARN236745363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult