Provider Demographics
NPI:1922434950
Name:LURIA, TERRY G (LSW, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:G
Last Name:LURIA
Suffix:
Gender:F
Credentials:LSW, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 STORER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5522
Mailing Address - Country:US
Mailing Address - Phone:216-651-1450
Mailing Address - Fax:216-651-4351
Practice Address - Street 1:1320 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2333
Practice Address - Country:US
Practice Address - Phone:216-781-0550
Practice Address - Fax:216-781-7501
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH923383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)