Provider Demographics
NPI:1902012313
Name:BORDAN, TERRY (EDD, LMHC, CCMHC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:BORDAN
Suffix:
Gender:F
Credentials:EDD, LMHC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4712
Mailing Address - Country:US
Mailing Address - Phone:516-883-1487
Mailing Address - Fax:516-467-4649
Practice Address - Street 1:128 VILLAGE GRN
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4712
Practice Address - Country:US
Practice Address - Phone:516-883-1487
Practice Address - Fax:516-467-4649
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health