Provider Demographics
NPI:1811717416
Name:WARD, TEIRRA NIYA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:TEIRRA
Middle Name:NIYA
Last Name:WARD
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 HARBORTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3088
Mailing Address - Country:US
Mailing Address - Phone:917-543-3809
Mailing Address - Fax:
Practice Address - Street 1:578 HARBORTOWN BLVD
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3088
Practice Address - Country:US
Practice Address - Phone:917-543-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070660001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical