Provider Demographics
NPI:1770189441
Name:WETTERAU, TED CONRAD III
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:CONRAD
Last Name:WETTERAU
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2246
Mailing Address - Country:US
Mailing Address - Phone:508-813-9400
Mailing Address - Fax:
Practice Address - Street 1:29 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2246
Practice Address - Country:US
Practice Address - Phone:508-813-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health