Provider Demographics
NPI:1629124342
Name:TEAL, SHAWN (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:TEAL
Suffix:
Gender:M
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OLD ROCHESTER RD STE 302
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2028
Mailing Address - Country:US
Mailing Address - Phone:978-457-9200
Mailing Address - Fax:
Practice Address - Street 1:6 OLD ROCHESTER RD STE 302
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2028
Practice Address - Country:US
Practice Address - Phone:978-457-9200
Practice Address - Fax:888-972-5019
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional