Provider Demographics
NPI:1740378900
Name:HARE, TERESA JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JANE
Last Name:HARE
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 1:1301 E ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4411
Mailing Address - Country:US
Mailing Address - Phone:602-993-7206
Mailing Address - Fax:
Practice Address - Street 1:3910 S RURAL RD STE J
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5567
Practice Address - Country:US
Practice Address - Phone:480-317-9868
Practice Address - Fax:480-317-9867
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-121211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical