Provider Demographics
NPI:1649938838
Name:TERESA YANDOW, LLC
Entity type:Organization
Organization Name:TERESA YANDOW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:YANDOW
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:802-495-1775
Mailing Address - Street 1:189 GREEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6329
Mailing Address - Country:US
Mailing Address - Phone:802-495-1775
Mailing Address - Fax:
Practice Address - Street 1:189 GREEN HILLS DR
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6329
Practice Address - Country:US
Practice Address - Phone:802-495-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty