Healthcare Provider Details

I. General information

NPI: 1164295663
Provider Name (Legal Business Name): LAURIE TERRES PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 W FRONT ST STE 11
RED BANK NJ
07701-1600
US

IV. Provider business mailing address

43 W FRONT ST STE 11
RED BANK NJ
07701-1600
US

V. Phone/Fax

Practice location:
  • Phone: 732-556-7404
  • Fax: 732-456-5071
Mailing address:
  • Phone: 732-556-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURIE M TERRES
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PSY.D.
Phone: 732-556-7404