Provider Demographics
NPI:1396317723
Name:BOSHEARS, TERESA ANN (MSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:BOSHEARS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18718 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9088
Mailing Address - Country:US
Mailing Address - Phone:443-889-9586
Mailing Address - Fax:
Practice Address - Street 1:18718 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9088
Practice Address - Country:US
Practice Address - Phone:443-889-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99103120A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1881848448OtherSCC NPI
IN26-3532969OtherSCC TAX ID
IN200929150AMedicaid
IN261QM0801XOtherSCC TAXONOMY