Provider Demographics
NPI:1104519016
Name:DAKUGINOW, TERESA MARIE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:DAKUGINOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-6035
Mailing Address - Country:US
Mailing Address - Phone:215-280-4014
Mailing Address - Fax:
Practice Address - Street 1:1880 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-6035
Practice Address - Country:US
Practice Address - Phone:215-280-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW009243L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker