Provider Demographics
NPI:1386219608
Name:MARTEL, TEAGAN S (MSW)
Entity Type:Individual
Prefix:
First Name:TEAGAN
Middle Name:S
Last Name:MARTEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 VT ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:EAST CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05650-8271
Mailing Address - Country:US
Mailing Address - Phone:802-793-7546
Mailing Address - Fax:802-225-6090
Practice Address - Street 1:356 VT ROUTE 14
Practice Address - Street 2:
Practice Address - City:EAST CALAIS
Practice Address - State:VT
Practice Address - Zip Code:05650-8271
Practice Address - Country:US
Practice Address - Phone:802-793-7546
Practice Address - Fax:802-225-6090
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134428104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT097.0134428OtherVERMONT REGISTRATION, NONLICENSED