Provider Demographics
NPI:1033521463
Name:BOBBIO, TERESA J
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:J
Last Name:BOBBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2218
Mailing Address - Country:US
Mailing Address - Phone:757-622-7017
Mailing Address - Fax:757-640-8402
Practice Address - Street 1:109 1/2 CLAY ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5205
Practice Address - Country:US
Practice Address - Phone:757-965-8663
Practice Address - Fax:757-539-8834
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040085851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12681722OtherCAQH