Provider Demographics
NPI:1669952206
Name:YESU, THERESA J (LICSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:YESU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SPRINGFIELD ST #12
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030
Mailing Address - Country:US
Mailing Address - Phone:413-786-4004
Mailing Address - Fax:
Practice Address - Street 1:1325 SPRINGFIELD ST #12
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030
Practice Address - Country:US
Practice Address - Phone:413-786-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical