Provider Demographics
NPI:1942444716
Name:TEITELBAUM-FEDER, PEARL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PEARL
Middle Name:
Last Name:TEITELBAUM-FEDER
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 1:13305 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1427
Mailing Address - Country:US
Mailing Address - Phone:718-490-8772
Mailing Address - Fax:
Practice Address - Street 1:13305 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1427
Practice Address - Country:US
Practice Address - Phone:718-490-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032477-11041C0700X
NY6928531041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool