Provider Demographics
NPI:1275788358
Name:PARRIS, THERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:PARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:PARRIS-PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4353 GUNTHER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1807
Mailing Address - Country:US
Mailing Address - Phone:718-231-3237
Mailing Address - Fax:
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-597-5559
Practice Address - Fax:718-597-7277
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0389561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical