Provider Demographics
NPI:1356806483
Name:GASPARD, TERRY JANETTE (LICSW)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:JANETTE
Last Name:GASPARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-2911
Mailing Address - Country:US
Mailing Address - Phone:508-328-7134
Mailing Address - Fax:
Practice Address - Street 1:42 VALLEY RD STE 3C
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6376
Practice Address - Country:US
Practice Address - Phone:401-842-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISWO12541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical