Provider Demographics
NPI:1780642587
Name:JETT, PAMELA A (MSW/LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:JETT
Suffix:
Gender:F
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 NE M CARI LN
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3743
Mailing Address - Country:US
Mailing Address - Phone:772-529-7403
Mailing Address - Fax:772-334-8104
Practice Address - Street 1:819 S FEDERAL HWY
Practice Address - Street 2:200B
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2952
Practice Address - Country:US
Practice Address - Phone:772-219-9566
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW33411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ60341Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER