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General NPI Number Information
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NPI Number | 1497408900
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Entity Type | Individual
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Provider Name | STEPHEN DEVERE MUNSON TERRANOVA PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 2080 CHILD STREET NAS JAX
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City | JACKSONVILLE
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State | FL
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Zip | 32214-0001
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Country | US
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Telephone | 904-546-7116
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Fax |
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Provider Business Mailing Address
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Address Line | 964 AJAX ST.
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City | JACKSONVILLE
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State | FL
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Zip | 32212
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Country | US
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Telephone | 904-546-7116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11102
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License Number State | FL
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