Provider Demographics
NPI:1053527788
Name:COCHRAN, TERESA (PHD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:COCHRAN
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:EAST ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02643-0129
Mailing Address - Country:US
Mailing Address - Phone:508-246-7618
Mailing Address - Fax:
Practice Address - Street 1:45 S ORLEANS RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2422
Practice Address - Country:US
Practice Address - Phone:508-246-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9934103T00000X, 102L00000X
VA0810001735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710278205OtherNPI PLLC