Provider Demographics
NPI:1154748523
Name:GLAZE-SHIELDS, TERESA (LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GLAZE-SHIELDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W 154TH PL
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3409
Mailing Address - Country:US
Mailing Address - Phone:708-922-9842
Mailing Address - Fax:708-922-9847
Practice Address - Street 1:235 W 154TH PL
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3409
Practice Address - Country:US
Practice Address - Phone:708-922-9842
Practice Address - Fax:708-922-9847
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0120031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical