Healthcare Provider Details

I. General information

NPI: 1083758973
Provider Name (Legal Business Name): TERI B LAWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MALCOLM FOREST RD
NEW CASTLE DE
19720-8746
US

IV. Provider business mailing address

160 MALCOLM FOREST RD
NEW CASTLE DE
19720-8746
US

V. Phone/Fax

Practice location:
  • Phone: 302-743-5486
  • Fax: 302-327-4822
Mailing address:
  • Phone: 302-743-5486
  • Fax: 302-327-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2101
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000970
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: