Provider Demographics
NPI:1457829038
Name:TERRENZI, MARTHA TAFT (LICSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:TAFT
Last Name:TERRENZI
Suffix:
Gender:F
Credentials:LICSW
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 851
Mailing Address - Street 2:
Mailing Address - City:SOUTH HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02661-0851
Mailing Address - Country:US
Mailing Address - Phone:508-360-9511
Mailing Address - Fax:
Practice Address - Street 1:6 STERLING RD
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-0264
Practice Address - Country:US
Practice Address - Phone:508-360-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1118631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty