Provider Demographics
NPI:1871735928
Name:NORRIS, THERESA ANN (MSSW, LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MSSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2405
Mailing Address - Country:US
Mailing Address - Phone:718-979-0673
Mailing Address - Fax:
Practice Address - Street 1:1076 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2405
Practice Address - Country:US
Practice Address - Phone:718-979-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032141-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical