Provider Demographics
NPI:1821418534
Name:RAFFERTY, TERRY M (LMSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:M
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 STATE HIGHWAY 310
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617
Mailing Address - Country:US
Mailing Address - Phone:315-386-2167
Mailing Address - Fax:315-386-2435
Practice Address - Street 1:80 STATE HIGHWAY 310
Practice Address - Street 2:SUITE 1
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-2167
Practice Address - Fax:315-386-2435
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLMSW-00049030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health