Provider Demographics
NPI:1205074341
Name:TERRY-MOORE, LYNETTE C (LMSW)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:C
Last Name:TERRY-MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 GRAND CONCOURSE
Mailing Address - Street 2:203
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5204
Mailing Address - Country:US
Mailing Address - Phone:718-817-7099
Mailing Address - Fax:718-817-7067
Practice Address - Street 1:2432 GRAND CONCOURSE
Practice Address - Street 2:203
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5204
Practice Address - Country:US
Practice Address - Phone:718-817-7099
Practice Address - Fax:718-817-7067
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0375841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical