Provider Demographics
NPI:1891880167
Name:PAVISH-PARADISO, TERESA L (MSW/LICSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:PAVISH-PARADISO
Suffix:
Gender:F
Credentials:MSW/LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALLA WALLA VAMC
Mailing Address - Street 2:77 WAINWRIGHT DRIVE
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3975
Mailing Address - Country:US
Mailing Address - Phone:509-525-5200
Mailing Address - Fax:509-527-3463
Practice Address - Street 1:WALLA WALLA VAMC
Practice Address - Street 2:77 WAINWRIGHT DRIVE
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3975
Practice Address - Country:US
Practice Address - Phone:509-525-5200
Practice Address - Fax:509-527-3463
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical