Provider Demographics
NPI:1023450475
Name:TERAI, MIKU (LCSW)
Entity type:Individual
Prefix:MS
First Name:MIKU
Middle Name:
Last Name:TERAI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DYRE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2510
Mailing Address - Country:US
Mailing Address - Phone:718-515-3000
Mailing Address - Fax:718-515-3097
Practice Address - Street 1:4010 DYRE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2510
Practice Address - Country:US
Practice Address - Phone:718-515-3000
Practice Address - Fax:718-515-3097
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0825031104100000X
NY08234211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker