Provider Demographics
NPI:1144046236
Name:TEAGUE, TONI EVANGELINE
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:EVANGELINE
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 1:24 COOPER DR FL 1
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1212
Mailing Address - Country:US
Mailing Address - Phone:973-462-0186
Mailing Address - Fax:
Practice Address - Street 1:2333 MORRIS AVE STE C206
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5739
Practice Address - Country:US
Practice Address - Phone:908-891-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO63598001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical