Provider Demographics
NPI:1114706165
Name:DAMIEN TERRONEZ LICENSED CLINICAL SOCIAL WORKER PC
Entity Type:Organization
Organization Name:DAMIEN TERRONEZ LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:559-495-5799
Mailing Address - Street 1:1840 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4078
Mailing Address - Country:US
Mailing Address - Phone:559-495-5799
Mailing Address - Fax:
Practice Address - Street 1:1840 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4078
Practice Address - Country:US
Practice Address - Phone:559-495-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty