Provider Demographics
NPI:1538686159
Name:ROSE-DISNEY, TERESSA DIMETRIA (MA)
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:DIMETRIA
Last Name:ROSE-DISNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 JO APTER PL
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-9214
Mailing Address - Country:US
Mailing Address - Phone:410-861-3695
Mailing Address - Fax:
Practice Address - Street 1:8609 2ND AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3360
Practice Address - Country:US
Practice Address - Phone:240-398-3514
Practice Address - Fax:877-637-7490
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty