Provider Demographics
NPI:1962684860
Name:TERRANOVA, RAYMOND DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DANIEL
Last Name:TERRANOVA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-2627
Mailing Address - Country:US
Mailing Address - Phone:908-894-3191
Mailing Address - Fax:
Practice Address - Street 1:6 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-2627
Practice Address - Country:US
Practice Address - Phone:908-894-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00431100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist