Healthcare Provider Details

I. General information

NPI: 1356245476
Provider Name (Legal Business Name): ANNABELLE ROSE TERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24727 ROUTE 6
TOWANDA PA
18848-8257
US

IV. Provider business mailing address

24727 ROUTE 6
TOWANDA PA
18848-8257
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-0100
  • Fax: 570-268-2756
Mailing address:
  • Phone: 570-265-0100
  • Fax: 570-268-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025453
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: