Provider Demographics
NPI:1568935856
Name:TEEVEN, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:TEEVEN
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 1:288 GROVE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3934
Mailing Address - Country:US
Mailing Address - Phone:508-318-7605
Mailing Address - Fax:508-318-7605
Practice Address - Street 1:288 GROVE ST STE 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3934
Practice Address - Country:US
Practice Address - Phone:508-318-7605
Practice Address - Fax:508-318-7605
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10002840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health