Provider Demographics
NPI:1821281122
Name:TERRANA, ANTOINETTE (MA, PC)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:TERRANA
Suffix:
Gender:F
Credentials:MA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CAREY LN
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3224
Mailing Address - Country:US
Mailing Address - Phone:570-883-1042
Mailing Address - Fax:
Practice Address - Street 1:22 CAREY LN
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3224
Practice Address - Country:US
Practice Address - Phone:570-883-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC002943OtherLICENSED COUNSELOR