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Provider Information for 1891925855


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BRIDGETTE L TERRAZAS LCSW


Other Names:  
Former Name: 
BRIDGETTE L JACQUEZ LCSW

Sex: Female

NPI: 1891925855
Last Updated: 2016-06-14
Certification Date:

Details

NameValue
NPI1891925855
Enumeration Date2009-07-23
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 9520 W PALM LN
SUITE 200
PHOENIX, AZ 85037-4403
United States

Phone: 623-583-3001 | Fax:623-583-3007
 
Primary Practice Address 1705 W MAIN ST
MESA, AZ 85201-6920
United States

Phone: 877-809-5092 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDAZ450425
MEDICAIDAZ463919
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalAZLCSW-11292