Provider Demographics
NPI:1497998470
Name:TEITELBAUM, JOY (LCSW-C; LDN)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:F
Credentials:LCSW-C; LDN
Other - Prefix:MRS
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:SOLYST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 OLD PASTURE LANE
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:410-975-5762
Mailing Address - Fax:
Practice Address - Street 1:513 OLD PASTURE LANE
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-975-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145021041C0700X
MDN00057133V00000X, 133VN1004X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic