Provider Demographics
NPI:1154142255
Name:HYVERNAUD, TREZINHA
Entity type:Individual
Prefix:
First Name:TREZINHA
Middle Name:
Last Name:HYVERNAUD
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 1:332 PARK ST APT A
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1143
Mailing Address - Country:US
Mailing Address - Phone:413-629-8552
Mailing Address - Fax:
Practice Address - Street 1:332 PARK ST APT A
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1143
Practice Address - Country:US
Practice Address - Phone:413-629-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician