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General NPI Number Information
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NPI Number | 1811447683
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Entity Type | Individual
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Provider Name | CHARLENE MARIE TERRY LCSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 01/06/2024
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Provider Practice Location Address
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Address Line | 39252 WINCHESTER RD STE 107-491
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City | MURRIETA
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State | CA
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Zip | 92563-3509
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Country | US
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Telephone | 951-587-1496
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Fax |
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Provider Business Mailing Address
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Address Line | 39252 WINCHESTER RD STE 107 491
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City | MURRIETA
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State | CA
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Zip | 92563-3509
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Country | US
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Telephone | 951-587-1496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 70366
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 94344
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License Number State | CA
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