Individual
FERNANDO TERRY I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
45 COUNTRY CLUB RD, ELLENVILLE, NY 12428-7113
(845) 321-4987
Mailing address
45 COUNTRY CLUB RD, ELLENVILLE, NY 12428-7113
(845) 321-4987
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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