Provider Demographics
NPI:1619402138
Name:TEEN, DALIA
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:TEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DALIA
Other - Middle Name:
Other - Last Name:TEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:10525 67TH RD
Mailing Address - Street 2:APT 3H
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2354
Mailing Address - Country:US
Mailing Address - Phone:917-710-8288
Mailing Address - Fax:
Practice Address - Street 1:10525 67TH RD
Practice Address - Street 2:APT 3H
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2354
Practice Address - Country:US
Practice Address - Phone:917-710-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker