Provider Demographics
NPI:1629253596
Name:MAGUIRE, TERESA KATHRYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:KATHRYN
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLAY CT
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2323
Mailing Address - Country:US
Mailing Address - Phone:516-632-5797
Mailing Address - Fax:516-432-4142
Practice Address - Street 1:19 DEAL RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1449
Practice Address - Country:US
Practice Address - Phone:516-632-5797
Practice Address - Fax:516-432-4142
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0559801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical