Provider Demographics
NPI:1003294364
Name:HAMMONTREE, JENNIFYR (MAAT)
Entity Type:Individual
Prefix:
First Name:JENNIFYR
Middle Name:
Last Name:HAMMONTREE
Suffix:
Gender:F
Credentials:MAAT
Other - Prefix:
Other - First Name:JENNIFYR
Other - Middle Name:
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAAT
Mailing Address - Street 1:3617 SW PARSONS ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3823
Practice Address - Country:US
Practice Address - Phone:772-320-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health