Provider Demographics
NPI:1083031595
Name:NORMAN, TERRA (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:928 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-9283
Mailing Address - Country:US
Mailing Address - Phone:812-549-0975
Mailing Address - Fax:
Practice Address - Street 1:928 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-9283
Practice Address - Country:US
Practice Address - Phone:812-549-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006827A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100240880Medicaid
IN12669617OtherCAQH
IN839090006Medicare PIN