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General NPI Number Information
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NPI Number | 1255053252
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Entity Type | Individual
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Provider Name | MARIANA DA COSTA TEAL LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 9920 PACIFIC HEIGHTS BLVD STE 150
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City | SAN DIEGO
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State | CA
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Zip | 92121-4361
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Country | US
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Telephone | 650-434-2563
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Fax |
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Provider Business Mailing Address
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Address Line | 9920 PACIFIC HEIGHTS BLVD STE 150
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City | SAN DIEGO
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State | CA
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Zip | 92121-4361
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Country | US
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Telephone | 650-434-2563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 89561
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License Number State | CA
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