Provider Demographics
NPI:1285643833
Name:MEYER, TERESA CANAL (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:CANAL
Last Name:MEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:CANAL
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:88 OLDE ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6769
Mailing Address - Country:US
Mailing Address - Phone:802-985-8202
Mailing Address - Fax:
Practice Address - Street 1:5138 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6698
Practice Address - Country:US
Practice Address - Phone:802-985-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT495103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005903Medicaid