Basic Information
| Provider Information | |||||||||
| NPI: | 1285002519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TELLER | ||||||||
| FirstName: | BRIANNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 VALLEY HEALTH PLZ | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076523607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
| FaxNumber: | 2012656908 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 VALLEY HEALTH PLZ | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076523607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
| FaxNumber: | 2012656908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC05582700 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.