Provider Demographics
NPI:1578978045
Name:JEANNETT, GERALD (MED)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:JEANNETT
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 FIRETHORN RD
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-2616
Mailing Address - Country:US
Mailing Address - Phone:412-720-7253
Mailing Address - Fax:
Practice Address - Street 1:89 FIRETHORN RD
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-2616
Practice Address - Country:US
Practice Address - Phone:412-720-7253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist