Provider Demographics
NPI:1790864114
Name:TERRY, ANNE B (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:B
Last Name:TERRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-4429
Mailing Address - Country:US
Mailing Address - Phone:508-524-2472
Mailing Address - Fax:508-880-5389
Practice Address - Street 1:171 HIGHLAND ST APT 303
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-4446
Practice Address - Country:US
Practice Address - Phone:508-386-2094
Practice Address - Fax:508-967-7194
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05498Medicare ID - Type Unspecified