Provider Demographics
NPI:1619959533
Name:MORETTO, JEAN EARLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:EARLENE
Last Name:MORETTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RHINEGARTEN DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8610
Mailing Address - Country:US
Mailing Address - Phone:314-839-3948
Mailing Address - Fax:314-731-4433
Practice Address - Street 1:737 DUNN RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1740
Practice Address - Country:US
Practice Address - Phone:314-731-2433
Practice Address - Fax:314-731-4433
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional