Healthcare Provider Details

I. General information

NPI: 1205676756
Provider Name (Legal Business Name): TEAH MARIE LOONEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WAKEMAN RD
FAIRFIELD CT
06824-5120
US

IV. Provider business mailing address

59 ERICKSON DR
STAMFORD CT
06903-3216
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-5078
  • Fax:
Mailing address:
  • Phone: 713-417-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9827
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: