Provider Demographics
NPI:1255602330
Name:VEVERKA, TERESA DAWN (MSW)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:DAWN
Last Name:VEVERKA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:BULLOCK
Other - Last Name:VEVERKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:10 PIER ONE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103
Mailing Address - Country:US
Mailing Address - Phone:503-789-6850
Mailing Address - Fax:888-971-4017
Practice Address - Street 1:10 PIER ONE
Practice Address - Street 2:SUITE 204
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-789-6850
Practice Address - Fax:888-971-4017
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORA4507104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health