Healthcare Provider Details

I. General information

NPI: 1720752975
Provider Name (Legal Business Name): TERRY B BERRIDGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MARSHALL ST
TRUTH OR CONSEQUENCES NM
87901-6600
US

IV. Provider business mailing address

900 MARSHALL ST
TRUTH OR CONSEQUENCES NM
87901-6600
US

V. Phone/Fax

Practice location:
  • Phone: 575-740-5096
  • Fax:
Mailing address:
  • Phone: 575-740-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0496
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: