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NPI Code Detail

MEDICARE: MR. FRANK H TELLER LCSW

MEDICARE: MR. FRANK H TELLER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker7913-123WI

General Provider Information

NPI Number : 1811296973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FRANK H TELLER LCSW
Provider Business Mailing Address
First Line : 1825 RIVERSIDE DR
Second Line : CATHOLIC CHARITIES
City : GREEN BAY
State : WI
Zip : 54301-2316
Country : US
Telephone Number : 920-272-8234
Fax Number : 920-437-4067
Provider Business Practice Location Address
First Line : 1825 RIVERSIDE DR
Second Line : CATHOLIC CHARITIES
City : GREEN BAY
State : WI
Zip : 54301-2316
Country : US
Telephone Number : 920-272-8234
Fax Number : 920-437-4067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2011
Last Update Date : 11/14/2012

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