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NPI Code Detail

MEDICARE: DR. STEPHEN DEVERE MUNSON TERRANOVA PSY.D.

MEDICARE: DR. STEPHEN DEVERE MUNSON TERRANOVA PSY.D.
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
1103T00000XPsychologist11102FL

General Provider Information

NPI Number : 1497408900
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN DEVERE MUNSON TERRANOVA PSY.D.
Provider Business Mailing Address
First Line : 964 AJAX ST.
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32212
Country : US
Telephone Number : 904-546-7116
Fax Number :
Provider Business Practice Location Address
First Line : 2080 CHILD STREET
Second Line : NAS JAX
City : JACKSONVILLE
State : FL
Zip : 32214-0001
Country : US
Telephone Number : 904-546-7116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2022
Last Update Date : 12/01/2025

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