Provider Demographics
NPI:1033355888
Name:PETETE, GARY DEWAYNE (MS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DEWAYNE
Last Name:PETETE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3105
Mailing Address - Country:US
Mailing Address - Phone:772-564-8616
Mailing Address - Fax:772-299-3757
Practice Address - Street 1:1455 33RD AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3105
Practice Address - Country:US
Practice Address - Phone:772-564-8616
Practice Address - Fax:772-299-3757
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health