Provider Demographics
NPI:1588705396
Name:STEVENSON, TERESA KATHLEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:KATHLEEN
Last Name:STEVENSON
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 1:157 BARCLAY RD APT A
Mailing Address - Street 2:P.O. BOX 352
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515-5018
Mailing Address - Country:US
Mailing Address - Phone:845-883-5403
Mailing Address - Fax:
Practice Address - Street 1:20 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2412
Practice Address - Country:US
Practice Address - Phone:845-486-2950
Practice Address - Fax:845-486-2999
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070484-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical