Provider Demographics
NPI:1275733131
Name:CHAMPINEY, TERRY LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:CHAMPINEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:LYNN
Other - Last Name:PICKREIGN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 BOWLES PARK
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-1512
Mailing Address - Country:US
Mailing Address - Phone:413-736-1590
Mailing Address - Fax:
Practice Address - Street 1:503 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4101
Practice Address - Country:US
Practice Address - Phone:413-733-6661
Practice Address - Fax:413-733-7841
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3131621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical