Provider Demographics
NPI:1841244563
Name:TETEN, NANCY ANN (LCSW, CAP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:TETEN
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:NOLAN
Other - Last Name:TETEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CAP
Mailing Address - Street 1:4001 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4808
Mailing Address - Country:US
Mailing Address - Phone:813-396-0615
Mailing Address - Fax:813-866-1612
Practice Address - Street 1:4001 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4808
Practice Address - Country:US
Practice Address - Phone:813-396-0615
Practice Address - Fax:813-866-1612
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP3122101YA0400X
FLSW74291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ073NXMedicare PIN