Basic Information
| Provider Information | |||||||||
| NPI: | 1912040882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERRY | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | MONTEITH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | GENETIC COUNSELOR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MONTEITH | ||||||||
| OtherFirstName: | TERESA | ||||||||
| OtherMiddleName: | AMY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | GENETIC COUNSELOR | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 114 WOODLAND ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607145062 | ||||||||
| FaxNumber: | 8607148073 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 WOODLAND ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607145062 | ||||||||
| FaxNumber: | 8607148073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 05/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.