Provider Demographics
NPI:1366635864
Name:TERRY, ROBIN RICARDO (BS SWSST)
Entity Type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:RICARDO
Last Name:TERRY
Suffix:
Gender:M
Credentials:BS SWSST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BAGLEY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226
Mailing Address - Country:US
Mailing Address - Phone:313-961-0346
Mailing Address - Fax:313-961-0456
Practice Address - Street 1:220 BAGLEY
Practice Address - Street 2:SUITE 700
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226
Practice Address - Country:US
Practice Address - Phone:313-961-0346
Practice Address - Fax:313-961-0456
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator