Provider Demographics
NPI:1114533890
Name:D'AVERSA, TERESA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:D'AVERSA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1836
Mailing Address - Country:US
Mailing Address - Phone:650-265-1193
Mailing Address - Fax:
Practice Address - Street 1:1005 W LARAWAY RD STE 230
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4117
Practice Address - Country:US
Practice Address - Phone:815-570-9303
Practice Address - Fax:866-950-9427
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1045941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical