Provider Demographics
NPI:1518280981
Name:FRONCILLO, JEANETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:FRONCILLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BAY DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4902
Mailing Address - Country:US
Mailing Address - Phone:727-433-0831
Mailing Address - Fax:727-303-3546
Practice Address - Street 1:2401 W BAY DR STE 117
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4902
Practice Address - Country:US
Practice Address - Phone:727-433-0831
Practice Address - Fax:727-303-3546
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8548103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty