Provider Demographics
NPI:1356548879
Name:REMBERT, JAQUAY WASHINGTON
Entity type:Individual
Prefix:
First Name:JAQUAY
Middle Name:WASHINGTON
Last Name:REMBERT
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 1:5338 KINGFISHERS CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-8918
Mailing Address - Country:US
Mailing Address - Phone:850-294-7584
Mailing Address - Fax:
Practice Address - Street 1:1204 MARION AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6514
Practice Address - Country:US
Practice Address - Phone:850-877-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW44321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical