Healthcare Provider Details

I. General information

NPI: 1427268739
Provider Name (Legal Business Name): JOSEPH TEGTMEIER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N WASHINGTON ST
WILMINGTON DE
19801-1509
US

IV. Provider business mailing address

764 OAK DR
DOVER DE
19904-4342
US

V. Phone/Fax

Practice location:
  • Phone: 302-577-6490
  • Fax: 302-577-6498
Mailing address:
  • Phone: 302-577-6490
  • Fax: 302-577-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000876
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: