Provider Demographics
NPI:1407175599
Name:HAWTHORNE, TERRIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-1201
Mailing Address - Country:US
Mailing Address - Phone:951-662-1989
Mailing Address - Fax:
Practice Address - Street 1:10957 GRASS VALLEY CIR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-3913
Practice Address - Country:US
Practice Address - Phone:951-662-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool