Provider Demographics
NPI:1043208507
Name:ADAMS, TERESA L (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S CENTER ST
Mailing Address - Street 2:STE 209
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1656
Mailing Address - Country:US
Mailing Address - Phone:814-471-9210
Mailing Address - Fax:814-471-2988
Practice Address - Street 1:104 S CENTER ST
Practice Address - Street 2:STE 209
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1656
Practice Address - Country:US
Practice Address - Phone:814-471-9210
Practice Address - Fax:814-471-2988
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013330104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
S88835Medicare UPIN
031265Medicare ID - Type Unspecified