Provider Demographics
NPI:1609493063
Name:TEITELBAUM, EMILY (LCSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:PRAWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2230 ROUTE 70 W STE 2
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3338
Mailing Address - Country:US
Mailing Address - Phone:201-321-9332
Mailing Address - Fax:
Practice Address - Street 1:2230 ROUTE 70 W STE 2
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3338
Practice Address - Country:US
Practice Address - Phone:201-321-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095607-011041C0700X
NJ44SC062529001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC06252900OtherSOCIAL WORK LICENSURE
NY095607-01OtherSOCIAL WORK LICENSURE
NY101-202OtherSOCIAL WORK LICENSURE