Provider Demographics
NPI:1992717730
Name:RIFKIN, TERRY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:A
Last Name:RIFKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERRY
Other - Middle Name:RIFKIN
Other - Last Name:HAWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30011 IVY GLENN DR
Mailing Address - Street 2:#206
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5014
Mailing Address - Country:US
Mailing Address - Phone:949-495-5007
Mailing Address - Fax:949-249-1993
Practice Address - Street 1:30011 IVY GLENN DR
Practice Address - Street 2:#206
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5014
Practice Address - Country:US
Practice Address - Phone:949-495-5007
Practice Address - Fax:949-249-1993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS8740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health