Provider Demographics
NPI:1083683767
Name:TEITELBAUM, CAROL ANN (MFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:TEITELBAUM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41750 RANCHO LAS PALMAS
Mailing Address - Street 2:#D2
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-346-4606
Mailing Address - Fax:760-346-4547
Practice Address - Street 1:41750 RANCHO LAS PALMAS
Practice Address - Street 2:#D2
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-346-4606
Practice Address - Fax:760-346-4547
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33BGB9OtherMEDICAL RIVERSIDE COUNTY