1912040882 NPI number — TERESA MONTEITH BERRY GENETIC COUNSELOR

Table of content: TERESA MONTEITH BERRY GENETIC COUNSELOR (NPI 1912040882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912040882 NPI number — TERESA MONTEITH BERRY GENETIC COUNSELOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRY
Provider First Name:
TERESA
Provider Middle Name:
MONTEITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
GENETIC COUNSELOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTEITH
Provider Other First Name:
TERESA
Provider Other Middle Name:
AMY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
GENETIC COUNSELOR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912040882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 WOODLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-5062
Provider Business Mailing Address Fax Number:
860-714-8073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 WOODLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-5062
Provider Business Practice Location Address Fax Number:
860-714-8073
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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