Provider Demographics
NPI:1649287285
Name:TERBRACK, KENNETH A (LMSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:TERBRACK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 TURNING BEND DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3235
Mailing Address - Country:US
Mailing Address - Phone:909-801-5762
Mailing Address - Fax:
Practice Address - Street 1:1325 E COOLEY DR
Practice Address - Street 2:READJUSTMENT COUNSELING, SAN BERNARDINO VET CENTER
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3947
Practice Address - Country:US
Practice Address - Phone:909-801-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010785911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical