Provider Demographics
NPI:1679992127
Name:TERRANO, PHILLIP F (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:F
Last Name:TERRANO
Suffix:
Gender:M
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 1:55 LAMBERT AVE.
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063
Mailing Address - Country:US
Mailing Address - Phone:716-672-8733
Mailing Address - Fax:716-672-8733
Practice Address - Street 1:55 LAMBERT AVE.
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14006
Practice Address - Country:US
Practice Address - Phone:716-672-8733
Practice Address - Fax:716-672-8733
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035319-1CERT#6670341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical