MEDICARE: TERENCE CLOWNEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2174	FL

General Provider Information

NPI Number	:	1104988419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERENCE CLOWNEY LCSW

Provider Business Mailing Address
First Line	:	1696 W HIBISCUS BLVD
Second Line	:	SUITE A
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2638
Country	:	US
Telephone Number	:	321-725-0554
Fax Number	:	321-952-0202

Provider Business Practice Location Address
First Line	:	1696 W HIBISCUS BLVD
Second Line	:	SUITE A
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2638
Country	:	US
Telephone Number	:	321-725-0554
Fax Number	:	321-952-0202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	01/31/2008

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