Provider Demographics
NPI:1780809939
Name:MCBRIDE, TERRENCE JAMES (MSW, PSYD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:JAMES
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:MSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1214
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3906
Mailing Address - Country:US
Mailing Address - Phone:310-208-7274
Mailing Address - Fax:323-851-8636
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1214
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-208-7274
Practice Address - Fax:323-851-8636
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 41731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW4173Medicare ID - Type Unspecified
CAR38682Medicare UPIN