Provider Demographics
NPI:1750661443
Name:PRICE, MARY TERESA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TERESA
Last Name:PRICE
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 1:123 TEA ROCK LN
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3152
Mailing Address - Country:US
Mailing Address - Phone:781-888-1279
Mailing Address - Fax:
Practice Address - Street 1:60 PERSEVERANCE WAY
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1843
Practice Address - Country:US
Practice Address - Phone:508-862-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor