Provider Demographics
NPI:1699285981
Name:FAULKNER, TERESA (MSED, CAS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MSED, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5390
Mailing Address - Country:US
Mailing Address - Phone:518-456-3268
Mailing Address - Fax:
Practice Address - Street 1:230 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5390
Practice Address - Country:US
Practice Address - Phone:518-456-3268
Practice Address - Fax:518-464-1469
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool