Healthcare Provider Details

I. General information

NPI: 1699670919
Provider Name (Legal Business Name): TERESA NOPPER LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MAIN RD, SUITE 7
AQUEBOGUE NY
11931-0034
US

IV. Provider business mailing address

1816 WADING RIVER MANOR RD # 385
WADING RIVER NY
11792-2195
US

V. Phone/Fax

Practice location:
  • Phone: 631-987-3594
  • Fax:
Mailing address:
  • Phone: 631-987-3594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERESA NOPPER
Title or Position: OWNER
Credential: LCSW
Phone: 631-987-3594