Provider Demographics
NPI:1356413793
Name:TERRUSO, ROBERT (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:TERRUSO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 86TH ST
Mailing Address - Street 2:PVT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3221
Mailing Address - Country:US
Mailing Address - Phone:718-748-8952
Mailing Address - Fax:212-815-1252
Practice Address - Street 1:1045 86TH ST
Practice Address - Street 2:PVT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3221
Practice Address - Country:US
Practice Address - Phone:718-748-8952
Practice Address - Fax:212-815-1252
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0159901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN16751Medicare ID - Type Unspecified