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General NPI Number Information
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NPI Number | 1396535688
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Entity Type | Individual
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Provider Name | KIMBERLY TEAHAN
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Gender | Female
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 20 JEROME AVE UNIT 340
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City | BLOOMFIELD
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State | CT
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Zip | 06002-4527
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Country | US
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Telephone | 203-903-7452
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Fax |
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Provider Business Mailing Address
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Address Line | 20 JEROME AVE UNIT 340
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City | BLOOMFIELD
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State | CT
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Zip | 06002-4527
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC10000286
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License Number State | MA
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