Michael Anton Terry, LCSW, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.011688 Issued in IL

Practice address

524 15TH St
Moline, IL 61265-2151

Phone

(309) 736-7170

Fax

(309) 736-7150

NPI assigned

Nov 25, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Everychild

  • Community/Behavioral Health Agency
  • Moline, IL
  • NPI 1518330182
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1891331872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 15TH ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612652151",
            "telephone_number": "309-736-7170",
            "fax_number": "309-736-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 15TH ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612652151",
            "telephone_number": "309-736-7170",
            "fax_number": "309-736-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRY",
        "first_name": "MICHAEL",
        "middle_name": "ANTON",
        "credential": "LCSW, LISW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "007851",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.011688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Christine Temmerman, MD
• Elizabeth E Temple, MD
• Mathilde Tengue
• Terrill M Baner M.D., LTD
• Joseph G Terry, PT
• Lucas Terveer, DPT
• Thomas Teslik
• Craig James Thatcher
• The Arc of the Quad Cities Area
• The Association for Retarded Citizens of Rock Island County

• Clinical Social Worker in Moline, IL
• Providers in Moline, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.