Healthcare Provider Details

I. General information

NPI: 1053527788
Provider Name (Legal Business Name): TERESA COCHRAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA COCHRAN ENGLISH PH.D.

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S ORLEANS RD
ORLEANS MA
02653-2422
US

IV. Provider business mailing address

PO BOX 129
EAST ORLEANS MA
02643-0129
US

V. Phone/Fax

Practice location:
  • Phone: 508-246-7618
  • Fax:
Mailing address:
  • Phone: 508-246-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9934
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number9934
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: