Provider Demographics
NPI:1942687314
Name:TESTRAKE, TERESA (LSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TESTRAKE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7052 ROUTE 6N
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-9610
Mailing Address - Country:US
Mailing Address - Phone:814-734-3975
Mailing Address - Fax:814-734-1265
Practice Address - Street 1:7052 ROUTE 6N
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-9610
Practice Address - Country:US
Practice Address - Phone:814-734-3975
Practice Address - Fax:814-734-1265
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130484104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030754740006Medicaid