Healthcare Provider Details

I. General information

NPI: 1194645374
Provider Name (Legal Business Name): DOROTHEA TERENZI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THEA TERENZI LMSW

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 14TH ST
WADING RIVER NY
11792-1924
US

IV. Provider business mailing address

4 14TH ST
WADING RIVER NY
11792-1924
US

V. Phone/Fax

Practice location:
  • Phone: 631-288-1122
  • Fax:
Mailing address:
  • Phone: 631-288-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: