Provider Demographics
NPI:1740580802
Name:TEAL, TYNISHA (MSW)
Entity Type:Individual
Prefix:
First Name:TYNISHA
Middle Name:
Last Name:TEAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HARTFORD TPKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4784
Mailing Address - Country:US
Mailing Address - Phone:860-896-5331
Mailing Address - Fax:860-896-5334
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:SUITE 201
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4784
Practice Address - Country:US
Practice Address - Phone:860-896-5331
Practice Address - Fax:860-896-5334
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool