Basic Information
| Provider Information | |||||||||
| NPI: | 1053869198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURRIAGO | ||||||||
| FirstName: | TERESA | ||||||||
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| NameSuffix: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 487 S. BROADWAY | ||||||||
| Address2: | YONKERS | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146688938 | ||||||||
| FaxNumber: | 9146682545 | ||||||||
| Practice Location | |||||||||
| Address1: | 487 S. BROADWAY, YONKERS | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146688938 | ||||||||
| FaxNumber: | 9146682545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 02/07/2017 | ||||||||
| NPIReactivationDate: | 07/06/2017 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 098254 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.