Provider Demographics
NPI:1619100229
Name:TEAHAN, PATRICK G (LICSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:G
Last Name:TEAHAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BALDWIN GREEN COMMON
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:617-767-8281
Mailing Address - Fax:
Practice Address - Street 1:3 BALDWIN GREEN COMMON
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:617-767-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-30
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1166421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical