Provider Demographics
NPI:1891910485
Name:VARELA, THERESA A (PHD, NPP)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:A
Last Name:VARELA
Suffix:
Gender:F
Credentials:PHD, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 13TH ST
Mailing Address - Street 2:203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6177
Mailing Address - Country:US
Mailing Address - Phone:718-788-2461
Mailing Address - Fax:718-788-8274
Practice Address - Street 1:348 13TH ST
Practice Address - Street 2:SUITE 202 & 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5004
Practice Address - Country:US
Practice Address - Phone:718-788-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400092-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health