Healthcare Provider Details

I. General information

NPI: 1831701630
Provider Name (Legal Business Name): DEBRA L. TERRY LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PHYLLIS DR STE G
PATCHOGUE NY
11772-2900
US

IV. Provider business mailing address

21 PINE TREE RD
HUNTINGTON STATION NY
11746-7428
US

V. Phone/Fax

Practice location:
  • Phone: 631-882-2940
  • Fax: 631-923-1579
Mailing address:
  • Phone: 631-882-2940
  • Fax: 631-923-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DEBRA L TERRY
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW-R
Phone: 631-882-2940