Provider Demographics
NPI:1447081617
Name:TODD, THERESE LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:LOUISE
Last Name:TODD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MERCER ST APT 1601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1590
Mailing Address - Country:US
Mailing Address - Phone:301-728-7654
Mailing Address - Fax:
Practice Address - Street 1:240 MERCER ST APT 1601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1590
Practice Address - Country:US
Practice Address - Phone:301-728-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical