Healthcare Provider Details

I. General information

NPI: 1710278205
Provider Name (Legal Business Name): TERESA COCHRAN PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 12/19/2016
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number9934
License Number StateMA

VIII. Authorized Official

Name: DR. TERESA COCHRAN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 508-246-7618