Provider Demographics
NPI:1841984341
Name:BURHOE, THERESA JILL (LCSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:JILL
Last Name:BURHOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1417
Mailing Address - Country:US
Mailing Address - Phone:603-493-1805
Mailing Address - Fax:
Practice Address - Street 1:372 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1417
Practice Address - Country:US
Practice Address - Phone:603-493-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW226091104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker