Provider Demographics
NPI:1861946337
Name:HEAD, THERESA (RBT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-0394
Mailing Address - Country:US
Mailing Address - Phone:508-901-1571
Mailing Address - Fax:
Practice Address - Street 1:14 TOMS WAY
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-6069
Practice Address - Country:US
Practice Address - Phone:508-901-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst