Provider Demographics
NPI:1578726345
Name:TAYLOR, THERESA A (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 NORTH AVE
Mailing Address - Street 2:APT. 3C6
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2702
Mailing Address - Country:US
Mailing Address - Phone:914-632-4549
Mailing Address - Fax:
Practice Address - Street 1:1273 NORTH AVE
Practice Address - Street 2:APT. 3C6
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2702
Practice Address - Country:US
Practice Address - Phone:914-632-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-035304-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical