Provider Demographics
NPI:1073609095
Name:TEEVEN, JOEL W (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:W
Last Name:TEEVEN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LINDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-6216
Mailing Address - Country:US
Mailing Address - Phone:781-893-8168
Mailing Address - Fax:781-893-8168
Practice Address - Street 1:521 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4191
Practice Address - Country:US
Practice Address - Phone:781-893-8168
Practice Address - Fax:781-893-8168
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10273421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07460OtherBLUE CROSS BLUE SHIELD
MA385304OtherMAGELLAN
MAP20327Medicare ID - Type UnspecifiedMEDICARE