Provider Demographics
NPI:1295586501
Name:PADRO SARAIVA, THERESA KRISTINE (MSP-A, CASAC-ADV)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:KRISTINE
Last Name:PADRO SARAIVA
Suffix:
Gender:F
Credentials:MSP-A, CASAC-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E 176TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4617
Mailing Address - Country:US
Mailing Address - Phone:718-583-5150
Mailing Address - Fax:
Practice Address - Street 1:770 E 176TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4617
Practice Address - Country:US
Practice Address - Phone:718-583-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37075101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)