Provider Demographics
NPI:1306110499
Name:DANA, TERESE P (BC ABA)
Entity type:Individual
Prefix:MRS
First Name:TERESE
Middle Name:P
Last Name:DANA
Suffix:
Gender:F
Credentials:BC ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:FRYEBURG
Mailing Address - State:ME
Mailing Address - Zip Code:04037
Mailing Address - Country:US
Mailing Address - Phone:207-935-1092
Mailing Address - Fax:207-935-1092
Practice Address - Street 1:2069 VILLAGE RD
Practice Address - Street 2:MADISON ELEMENTARY SCHOOL
Practice Address - City:MADISON
Practice Address - State:NH
Practice Address - Zip Code:03849
Practice Address - Country:US
Practice Address - Phone:603-367-4642
Practice Address - Fax:603-367-8784
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
11314501OtherAETNA