Provider Demographics
NPI:1275920456
Name:DRAKE, TERRY (LSW)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:DRAKE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MCINROY ST
Mailing Address - Street 2:APT. A
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 MCINROY ST
Practice Address - Street 2:APT. A
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1607
Practice Address - Country:US
Practice Address - Phone:570-244-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW122848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker