Provider Demographics
NPI:1063092872
Name:DWYER, ANN TERESE (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:TERESE
Last Name:DWYER
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 LEDGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3073
Mailing Address - Country:US
Mailing Address - Phone:603-966-9662
Mailing Address - Fax:
Practice Address - Street 1:139 LEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3073
Practice Address - Country:US
Practice Address - Phone:603-966-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21881103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH21881Medicaid
NH28881Medicaid