Provider Demographics
NPI:1932345824
Name:NELSON, TERESA ALCANTAR (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ALCANTAR
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:ALCANTAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3711 LONG BEACH BLVD STE 5035
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3315
Mailing Address - Country:US
Mailing Address - Phone:323-528-3447
Mailing Address - Fax:
Practice Address - Street 1:649 E ALBERTONI ST STE 100
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1538
Practice Address - Country:US
Practice Address - Phone:310-436-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical