Provider Demographics
NPI:1437302411
Name:VISINTINE, TERESA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:VISINTINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:OAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 JUNCTION DR W
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-2931
Mailing Address - Country:US
Mailing Address - Phone:618-207-4018
Mailing Address - Fax:618-205-3990
Practice Address - Street 1:9 JUNCTION DR W
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2931
Practice Address - Country:US
Practice Address - Phone:618-207-4018
Practice Address - Fax:618-205-3990
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490058011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical