Provider Demographics
NPI:1750786851
Name:CHERY, TERESA (CASAC-T)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CHERY
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 UNIONDALE AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1401
Mailing Address - Country:US
Mailing Address - Phone:516-784-1330
Mailing Address - Fax:
Practice Address - Street 1:176 UNIONDALE AVE
Practice Address - Street 2:FL 2
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-1401
Practice Address - Country:US
Practice Address - Phone:516-784-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-T #30550101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)