Provider Demographics
NPI:1770849382
Name:TEAPE, KENNETH LOUIS
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LOUIS
Last Name:TEAPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARK DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3830
Mailing Address - Country:US
Mailing Address - Phone:631-544-9206
Mailing Address - Fax:
Practice Address - Street 1:15 PARK DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3830
Practice Address - Country:US
Practice Address - Phone:631-544-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities