Provider Demographics
NPI:1043349749
Name:IZQUIERDO, TERESA G (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:G
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 US HIGHWAY 42 STE 3
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1999
Mailing Address - Country:US
Mailing Address - Phone:859-869-4463
Mailing Address - Fax:859-869-4476
Practice Address - Street 1:7413 US HIGHWAY 42 STE 3
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1999
Practice Address - Country:US
Practice Address - Phone:859-869-4463
Practice Address - Fax:859-869-4476
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5985103TC0700X
KY130270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1467997361OtherGROUP PRACTICE NPI IDENTIFICATION FOR FORWARD FOCUS PAYCHOLOGICAL ASSOCIATES