Provider Demographics
NPI:1588946990
Name:OCHOA TEO, TIANA T (LICSW)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:T
Last Name:OCHOA TEO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 BROADWAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1468
Mailing Address - Country:US
Mailing Address - Phone:401-692-4353
Mailing Address - Fax:
Practice Address - Street 1:390 BROADWAY UNIT 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1468
Practice Address - Country:US
Practice Address - Phone:401-692-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW027761041C0700X
RICSW01416104100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist