Laurie B Teal, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

101-0131597 Issued in VT

Practice address

725 Juniper Swamp Rd
Shushan, NY 12873-2910

Phone

(518) 812-6842

Fax

(518) 338-0174

NPI assigned

Jun 21, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 7, 2018 through Dec 7, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Laurie B Teal Integrative Wellness NP in Psychiatry, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Shushan, NY
  • NPI 1154072395
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1114447166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 JUNIPER SWAMP RD",
            "city": "SHUSHAN",
            "state": "NY",
            "postal_code": "128732910",
            "telephone_number": "518-812-6842",
            "fax_number": "518-338-0174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 JUNIPER SWAMP RD",
            "city": "SHUSHAN",
            "state": "NY",
            "postal_code": "128732910",
            "telephone_number": "518-812-6842",
            "fax_number": "518-338-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEAL",
        "first_name": "LAURIE",
        "middle_name": "B",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VT",
            "license": "101-0131597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Canalini, LICSW
• Karin Elisabeth Foster
• Laurie B Teal Integrative Wellness NP in Psychiatry, PLLC

• Psychiatric/Mental Health Nurse Practitioner in Shushan, NY
• Providers in Shushan, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.