Healthcare Provider Details

I. General information

NPI: 1841244563
Provider Name (Legal Business Name): NANCY ANN TETEN LCSW, CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY NOLAN TETEN LCSW, CAP

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 E FLETCHER AVE
TAMPA FL
33613-4808
US

IV. Provider business mailing address

4001 E FLETCHER AVE
TAMPA FL
33613-4808
US

V. Phone/Fax

Practice location:
  • Phone: 813-396-0615
  • Fax: 813-866-1612
Mailing address:
  • Phone: 813-396-0615
  • Fax: 813-866-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP3122
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: