Provider Demographics
NPI:1366634685
Name:CARR, TERRY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD STE 850
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1393
Mailing Address - Country:US
Mailing Address - Phone:414-536-8604
Mailing Address - Fax:414-536-8605
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 850
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-536-8604
Practice Address - Fax:414-536-8605
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3090 1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391398029028OtherBLUE CROSS BLUE SHIELD
WI930564044001OtherBLUE CROSS BLUE SHIELD