Provider Demographics
NPI:1447473673
Name:FERNS, THERESA JANE (MA, PHD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:JANE
Last Name:FERNS
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3837
Mailing Address - Country:US
Mailing Address - Phone:603-224-2841
Mailing Address - Fax:603-228-6018
Practice Address - Street 1:85 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3837
Practice Address - Country:US
Practice Address - Phone:603-224-2841
Practice Address - Fax:603-228-6018
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30420519Medicaid