Provider Demographics
NPI:1063901544
Name:MERRILL, THERESA M
Entity type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:M
Last Name:MERRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-5525
Mailing Address - Country:US
Mailing Address - Phone:401-365-7849
Mailing Address - Fax:
Practice Address - Street 1:309 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-5525
Practice Address - Country:US
Practice Address - Phone:401-365-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst