Healthcare Provider Details

I. General information

NPI: 1205511177
Provider Name (Legal Business Name): MARIA TERESA TAVERAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6729 MYRTLE AVE
GLENDALE NY
11385-7063
US

IV. Provider business mailing address

190 FORSYTH ST APT 3C
NEW YORK NY
10002-1364
US

V. Phone/Fax

Practice location:
  • Phone: 718-456-7001
  • Fax:
Mailing address:
  • Phone: 347-433-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number084015
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number084015
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number084015
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number084015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: