Provider Demographics
NPI:1659472421
Name:TESSIER, WAYNE GERARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GERARD
Last Name:TESSIER
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 1:52 BRIGHAM ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2210
Mailing Address - Country:US
Mailing Address - Phone:508-993-8332
Mailing Address - Fax:
Practice Address - Street 1:52 BRIGHAM ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2210
Practice Address - Country:US
Practice Address - Phone:508-993-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4959103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0520187Medicaid
MA0520187Medicaid
MAW04965Medicare UPIN