Provider Demographics
NPI:1891925855
Name:TERRAZAS, BRIDGETTE L (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:L
Last Name:TERRAZAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:L
Other - Last Name:JACQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9520 W PALM LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:623-583-3001
Mailing Address - Fax:623-583-3007
Practice Address - Street 1:1705 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6920
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-112921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ450425Medicaid
AZ463919Medicaid