Provider Demographics
NPI:1164029971
Name:HUERTAS, TEESHA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:TEESHA
Middle Name:MARIE
Last Name:HUERTAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4404
Mailing Address - Country:US
Mailing Address - Phone:508-764-2455
Mailing Address - Fax:
Practice Address - Street 1:58 HIGH ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5106
Practice Address - Country:US
Practice Address - Phone:860-983-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2244971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical