Provider Demographics
NPI:1710069588
Name:TERRES, LAURIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:TERRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 W FRONT ST STE 11
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1600
Mailing Address - Country:US
Mailing Address - Phone:732-556-7404
Mailing Address - Fax:732-456-5071
Practice Address - Street 1:43 W FRONT ST STE 11
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1600
Practice Address - Country:US
Practice Address - Phone:732-556-7404
Practice Address - Fax:732-456-5071
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00433700103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral