Provider Demographics
NPI:1689435687
Name:QUADRES, TERESA COLLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:COLLEEN
Last Name:QUADRES
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 1:210 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1242
Mailing Address - Country:US
Mailing Address - Phone:831-252-1714
Mailing Address - Fax:
Practice Address - Street 1:5905 SOQUEL DR STE 350
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2850
Practice Address - Country:US
Practice Address - Phone:831-252-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS243591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical