Provider Demographics
NPI:1710384623
Name:TENEYCK, PAMELA LYNN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:TENEYCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BALCOM ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2009
Mailing Address - Country:US
Mailing Address - Phone:508-339-5155
Mailing Address - Fax:
Practice Address - Street 1:94 BALCOM ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2009
Practice Address - Country:US
Practice Address - Phone:508-339-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-07-3690103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst