Provider Demographics
NPI:1770649576
Name:DIPENTO, JEANNETTE ELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:ELENA
Last Name:DIPENTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 3RD LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4346
Mailing Address - Country:US
Mailing Address - Phone:561-965-2026
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKE WORTH RD
Practice Address - Street 2:SUITE112
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4727
Practice Address - Country:US
Practice Address - Phone:561-963-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00024721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4549Medicare ID - Type Unspecified