Provider Demographics
NPI:1689729956
Name:TEAGUE, COLLEEN A (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:A
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:A
Other - Last Name:TEAGUE-CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:72 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1416
Mailing Address - Country:US
Mailing Address - Phone:617-894-2073
Mailing Address - Fax:
Practice Address - Street 1:72 CROSS ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1416
Practice Address - Country:US
Practice Address - Phone:617-894-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical