Provider Demographics
NPI:1336110675
Name:DUNN, TERESA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DUNN
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 1:1428 MANZANO ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5019
Mailing Address - Country:US
Mailing Address - Phone:928-607-2801
Mailing Address - Fax:
Practice Address - Street 1:1428 MANZANO ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5019
Practice Address - Country:US
Practice Address - Phone:928-607-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-01121041C0700X
AZLCSW103971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ774861Medicaid
AZ860663432OtherTIN