Provider Demographics
NPI:1740678648
Name:TESLEV-KLETT, VIOLETA A (LCSW)
Entity type:Individual
Prefix:
First Name:VIOLETA
Middle Name:A
Last Name:TESLEV-KLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MONTROSE TPKE
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-6925
Mailing Address - Country:US
Mailing Address - Phone:917-283-7314
Mailing Address - Fax:
Practice Address - Street 1:54 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1325
Practice Address - Country:US
Practice Address - Phone:607-307-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0876991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical