Healthcare Provider Details

I. General information

NPI: 1588681795
Provider Name (Legal Business Name): TERESA P. BAIROS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 NEWMAN AVE
RUMFORD RI
02916-1218
US

IV. Provider business mailing address

225 NEWMAN AVE
RUMFORD RI
02916-1218
US

V. Phone/Fax

Practice location:
  • Phone: 401-467-9610
  • Fax: 401-467-9030
Mailing address:
  • Phone: 401-475-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMFT00093
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: