Provider Demographics
NPI:1235985458
Name:TERZIS, STAVRITSA (LMSW)
Entity type:Individual
Prefix:
First Name:STAVRITSA
Middle Name:
Last Name:TERZIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 OXFORD ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2915
Mailing Address - Country:US
Mailing Address - Phone:203-240-6199
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST STE 1311
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2700
Practice Address - Country:US
Practice Address - Phone:860-461-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty