Provider Demographics
NPI:1013987403
Name:MAYO, TERESA M (MED, PSYD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
Last Name:MAYO
Suffix:
Gender:F
Credentials:MED, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3807
Mailing Address - Country:US
Mailing Address - Phone:207-215-3488
Mailing Address - Fax:
Practice Address - Street 1:250 ARSENAL ST
Practice Address - Street 2:11 SHS
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0001
Practice Address - Country:US
Practice Address - Phone:207-624-4664
Practice Address - Fax:207-287-6123
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS 1000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8715OtherPIN