Provider Demographics
NPI:1063727170
Name:VINCENT, THERESA M (LMHC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 SILVER ST
Mailing Address - Street 2:UNIT 106
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3065
Mailing Address - Country:US
Mailing Address - Phone:413-789-9198
Mailing Address - Fax:413-789-6322
Practice Address - Street 1:200 SILVER ST
Practice Address - Street 2:UNIT 106
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3065
Practice Address - Country:US
Practice Address - Phone:413-789-9198
Practice Address - Fax:413-789-6322
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health