Provider Demographics
NPI:1851805949
Name:TEODORO, KENIA BAIA
Entity Type:Individual
Prefix:MRS
First Name:KENIA
Middle Name:BAIA
Last Name:TEODORO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KENIA
Other - Middle Name:
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-0472
Mailing Address - Country:US
Mailing Address - Phone:774-208-1460
Mailing Address - Fax:
Practice Address - Street 1:29 BASSETT LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3813
Practice Address - Country:US
Practice Address - Phone:508-862-0273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst