Provider Demographics
NPI:1700238847
Name:QUARLES, TERESA (MS MHC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:QUARLES
Suffix:
Gender:F
Credentials:MS MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14469 177TH PL FL 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4921
Mailing Address - Country:US
Mailing Address - Phone:347-306-8340
Mailing Address - Fax:
Practice Address - Street 1:14469 177TH PL FL 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4921
Practice Address - Country:US
Practice Address - Phone:347-306-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling