Healthcare Provider Details

I. General information

NPI: 1710707914
Provider Name (Legal Business Name): TERESA DEVLIN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 MAIN ST
HANSON MA
02341-1938
US

IV. Provider business mailing address

195 MAIN ST
HANSON MA
02341-1938
US

V. Phone/Fax

Practice location:
  • Phone: 617-755-6784
  • Fax:
Mailing address:
  • Phone: 617-755-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127481
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: