Provider Demographics
NPI:1215059159
Name:TWICHELL, TERRY L (MSW LCSWR)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:TWICHELL
Suffix:
Gender:M
Credentials:MSW LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 ELM ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1414
Mailing Address - Country:US
Mailing Address - Phone:315-476-4050
Mailing Address - Fax:315-425-7268
Practice Address - Street 1:312 ELM ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1414
Practice Address - Country:US
Practice Address - Phone:315-476-4050
Practice Address - Fax:315-425-7268
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02552911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
56842BMedicare ID - Type Unspecified