Provider Demographics
NPI:1215037619
Name:MESSINA, TERI A (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:A
Last Name:MESSINA
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2240
Mailing Address - Country:US
Mailing Address - Phone:516-674-3772
Mailing Address - Fax:
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:202
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4309
Practice Address - Country:US
Practice Address - Phone:516-674-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03515811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR0351581OtherLICENSE NUMBER
NYR0351581OtherLICENSE NUMBER