Provider Demographics
NPI:1760856744
Name:UKATTAH, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:UKATTAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-8312
Mailing Address - Country:US
Mailing Address - Phone:917-826-1465
Mailing Address - Fax:
Practice Address - Street 1:47 MADELEINE AVE
Practice Address - Street 2:2
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-3616
Practice Address - Country:US
Practice Address - Phone:917-826-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator