Provider Demographics
NPI:1740382241
Name:SURINSKY, TERRY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:
Last Name:SURINSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 SHOREHAM PL STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5976
Mailing Address - Country:US
Mailing Address - Phone:866-657-6592
Mailing Address - Fax:
Practice Address - Street 1:5060 SHOREHAM PL STE 330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5976
Practice Address - Country:US
Practice Address - Phone:866-657-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0027621041C0700X
CA609371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty