Provider Demographics
NPI:1477952109
Name:FOSTER, TERESA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:R
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N. COLLEGE AVENUE
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404
Mailing Address - Country:US
Mailing Address - Phone:812-272-3028
Mailing Address - Fax:844-596-3392
Practice Address - Street 1:205 N. COLLEGE AVENUE
Practice Address - Street 2:SUITE 210B
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404
Practice Address - Country:US
Practice Address - Phone:812-272-3028
Practice Address - Fax:844-596-3392
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006634A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical