Provider Demographics
NPI:1356521579
Name:TEACHER, TERESA ELIZABETH (LCSW)
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:ELIZABETH
Last Name:TEACHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:TEACHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8122 S SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5008
Mailing Address - Country:US
Mailing Address - Phone:773-617-0566
Mailing Address - Fax:626-639-3241
Practice Address - Street 1:27120 EUCALYPTUS AVE # 435
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4543
Practice Address - Country:US
Practice Address - Phone:773-617-0566
Practice Address - Fax:626-639-3241
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA794741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty