Provider Demographics
NPI:1053349076
Name:LONERGAN, TERRENCE M (MA)
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:M
Last Name:LONERGAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 SEAFOX RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5646
Mailing Address - Country:US
Mailing Address - Phone:941-429-6100
Mailing Address - Fax:941-426-9147
Practice Address - Street 1:5400 S BISCAYNE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1932
Practice Address - Country:US
Practice Address - Phone:941-429-6100
Practice Address - Fax:941-426-9147
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional