Provider Demographics
NPI:1982761359
Name:YANDOW, TERESA M (LICSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:YANDOW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 GREEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6329
Mailing Address - Country:US
Mailing Address - Phone:774-249-5280
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST STE 4C
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8350
Practice Address - Country:US
Practice Address - Phone:802-495-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00011621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013354Medicaid