| Doctor Name: | THERESA M VINCENT |
| NPI Number: | 1063727170 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | 1241 |
| Business Practice Address: | 200 Silver St Unit 106 Agawam, MA - 010013065 |
| Business Phone Number: | 4137899198 |
| Business Fax Number: | 4137896322 |
| Mailing Address: | 200 Silver St, Unit 106 AGAWAM |
| State: | MA |
| Postal Code: | 010013065 |
| Phone Number: | 4137899198 |
| Fax Number: | 4137896322 |
| NPI Enumeration Date: | 08/12/2010 |
| NPI Last Update Date: | 08/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 1241 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |