Provider Demographics
NPI:1013125376
Name:NEZWORSKI, M TERESA (PHD)
Entity Type:Individual
Prefix:DR
First Name:M TERESA
Middle Name:
Last Name:NEZWORSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY TERESA
Other - Middle Name:
Other - Last Name:NEZWORSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:300 SKYVIEW, # H8
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3134
Mailing Address - Country:US
Mailing Address - Phone:915-244-7764
Mailing Address - Fax:
Practice Address - Street 1:300 SKYVIEW, # H8
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3134
Practice Address - Country:US
Practice Address - Phone:915-244-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24487103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TH0004X, 103TH0100X, 103TM1800X, 103TP2701X
TX6535103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool