Provider Demographics
NPI:1457363061
Name:TERREBONNE, ADELBERT (MSW)
Entity Type:Individual
Prefix:MR
First Name:ADELBERT
Middle Name:
Last Name:TERREBONNE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:TERREBONNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:4924 VALJEAN AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1336
Mailing Address - Country:US
Mailing Address - Phone:818-788-6942
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2921
Practice Address - Country:US
Practice Address - Phone:818-788-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 125121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical