| Doctor Name: | MARY TERO |
| NPI Number: | 1063831840 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CAP |
| License Number: | 5722 |
| Business Practice Address: | 1700 Education Ave Punta Gorda, FL - 339506222 |
| Business Phone Number: | 9416398300 |
| Business Fax Number: | 9413476493 |
| Mailing Address: | 1700 Education Ave, PUNTA GORDA |
| State: | FL |
| Postal Code: | 339506222 |
| Phone Number: | 9416398300 |
| Fax Number: | 9413476493 |
| NPI Enumeration Date: | 04/09/2014 |
| NPI Last Update Date: | 04/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 5722 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |