Provider Demographics
NPI:1801077805
Name:DEBOER, TERESA GIAMMELLA (LMHC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:GIAMMELLA
Last Name:DEBOER
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 BARD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3320
Mailing Address - Country:US
Mailing Address - Phone:718-354-7807
Mailing Address - Fax:
Practice Address - Street 1:835 BARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3320
Practice Address - Country:US
Practice Address - Phone:718-354-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002797101YM0800X
NY000259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health