Provider Demographics
NPI:1851500946
Name:TEPPER, JEANETTA GRIFFITH (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANETTA
Middle Name:GRIFFITH
Last Name:TEPPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANETTA
Other - Middle Name:REBECCA
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW; ACSW
Mailing Address - Street 1:26420 LUCKY STONE ROAD
Mailing Address - Street 2:UNIT #102
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-405-1314
Mailing Address - Fax:239-594-8762
Practice Address - Street 1:1750 SW HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0420
Practice Address - Country:US
Practice Address - Phone:239-405-1314
Practice Address - Fax:239-566-7355
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76461041C0700X
IN34000373A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical