Provider Demographics
NPI:1851061816
Name:TEAGUE, GIANNA C P
Entity type:Individual
Prefix:
First Name:GIANNA
Middle Name:C P
Last Name:TEAGUE
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 1:555 AMORY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2652
Mailing Address - Country:US
Mailing Address - Phone:857-399-1920
Mailing Address - Fax:
Practice Address - Street 1:555 AMORY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2652
Practice Address - Country:US
Practice Address - Phone:857-399-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker