Provider Demographics
NPI:1518525518
Name:BORETTI, JENNIFER DECRE (MSW, LCSW-C, LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DECRE
Last Name:BORETTI
Suffix:
Gender:F
Credentials:MSW, LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 EAGLES WING LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-7934
Mailing Address - Country:US
Mailing Address - Phone:919-339-9981
Mailing Address - Fax:
Practice Address - Street 1:2154 EAGLES WING LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-7934
Practice Address - Country:US
Practice Address - Phone:919-339-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127671041C0700X
NCC0117761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical