Provider Demographics
NPI:1558426189
Name:FUNK-ANTMAN, TERRY (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:
Last Name:FUNK-ANTMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NEHER ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1437
Mailing Address - Country:US
Mailing Address - Phone:845-679-2825
Mailing Address - Fax:
Practice Address - Street 1:20 NEHER ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1437
Practice Address - Country:US
Practice Address - Phone:845-679-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028053-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical