Provider Demographics
NPI:1801925821
Name:HUGHES, TEDI PATRICIA (PMHCNS , BC)
Entity type:Individual
Prefix:MS
First Name:TEDI
Middle Name:PATRICIA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PMHCNS , BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1757
Mailing Address - Country:US
Mailing Address - Phone:617-264-5364
Mailing Address - Fax:
Practice Address - Street 1:161 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4885
Practice Address - Country:US
Practice Address - Phone:617-264-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161768163WP0807X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent