Provider Demographics
NPI:1275005829
Name:TEITELBAUM, ERIC (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5944
Mailing Address - Country:US
Mailing Address - Phone:203-934-9400
Mailing Address - Fax:
Practice Address - Street 1:1 LONG WHARF DR STE 102
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5944
Practice Address - Country:US
Practice Address - Phone:203-349-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1016921041C0700X
CT0123451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical