Provider Demographics
NPI:1710288691
Name:ZELAYA, THERESA M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:ZELAYA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 MOTT AVE
Mailing Address - Street 2:410
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4100
Mailing Address - Country:US
Mailing Address - Phone:347-297-1056
Mailing Address - Fax:718-337-2750
Practice Address - Street 1:1931 MOTT AVE
Practice Address - Street 2:410
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4100
Practice Address - Country:US
Practice Address - Phone:347-297-1056
Practice Address - Fax:718-337-2750
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069977-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical