Provider Demographics
NPI:1104988419
Name:CLOWNEY, TERENCE (LCSW)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:CLOWNEY
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 1:1696 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2638
Mailing Address - Country:US
Mailing Address - Phone:321-725-0554
Mailing Address - Fax:321-952-0202
Practice Address - Street 1:1696 W HIBISCUS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2638
Practice Address - Country:US
Practice Address - Phone:321-725-0554
Practice Address - Fax:321-952-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2634Medicare ID - Type Unspecified