Provider Demographics
NPI:1821752965
Name:CHERUBINI, JEANETTE (CAP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:CHERUBINI
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:KILROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAP
Mailing Address - Street 1:5556 PLEASANT PINES CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-8930
Mailing Address - Country:US
Mailing Address - Phone:850-274-2979
Mailing Address - Fax:
Practice Address - Street 1:2940 E PARK AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3446
Practice Address - Country:US
Practice Address - Phone:850-274-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health