Healthcare Provider Details

I. General information

NPI: 1336110675
Provider Name (Legal Business Name): TERESA DUNN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MANZANO ST NE
ALBUQUERQUE NM
87110-5019
US

IV. Provider business mailing address

1428 MANZANO ST NE
ALBUQUERQUE NM
87110-5019
US

V. Phone/Fax

Practice location:
  • Phone: 928-607-2801
  • Fax:
Mailing address:
  • Phone: 928-607-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0112
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW10397
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: