Provider Demographics
NPI:1104956978
Name:TERRANOVA, NICHOLAS PETER (LCSW)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:PETER
Last Name:TERRANOVA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SOUTH BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-598-4101
Mailing Address - Fax:813-870-1726
Practice Address - Street 1:219 S BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3002
Practice Address - Country:US
Practice Address - Phone:813-598-4101
Practice Address - Fax:813-870-1726
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-0004116103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26968Medicare ID - Type Unspecified