Provider Demographics
NPI:1629699129
Name:SOMMERS, JUSTINE RENEE
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:RENEE
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NW SWANN MILL CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3591
Mailing Address - Country:US
Mailing Address - Phone:724-972-2827
Mailing Address - Fax:
Practice Address - Street 1:131 NW SWANN MILL CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3591
Practice Address - Country:US
Practice Address - Phone:724-972-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health