Provider Demographics
NPI:1194508549
Name:TEIXEIRA, ANTONIO PAULO PERREIRA JR
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:PAULO PERREIRA
Last Name:TEIXEIRA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 STILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3130
Mailing Address - Country:US
Mailing Address - Phone:386-507-3581
Mailing Address - Fax:
Practice Address - Street 1:91 STILLMAN AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3130
Practice Address - Country:US
Practice Address - Phone:386-507-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor