Provider Demographics
NPI:1518473594
Name:WERP LLC
Entity Type:Organization
Organization Name:WERP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PREWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-316-2259
Mailing Address - Street 1:5291 COLLINS RD LOT 293
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5389
Mailing Address - Country:US
Mailing Address - Phone:904-316-2259
Mailing Address - Fax:
Practice Address - Street 1:5291 COLLINS RD LOT 293
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5389
Practice Address - Country:US
Practice Address - Phone:904-316-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health