Provider Demographics
NPI:1518104330
Name:TERRONEZ, DAMIEN GABRIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:GABRIEL
Last Name:TERRONEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 WILLOW AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4750
Mailing Address - Country:US
Mailing Address - Phone:559-495-5799
Mailing Address - Fax:
Practice Address - Street 1:3114 WILLOW AVE
Practice Address - Street 2:STE 102
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4750
Practice Address - Country:US
Practice Address - Phone:559-495-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 289081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical