Provider Demographics
NPI:1740670983
Name:FRATUS, JENNIE
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:FRATUS
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 1:15222 ROBERTS WAY
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4238
Mailing Address - Country:US
Mailing Address - Phone:561-386-4259
Mailing Address - Fax:
Practice Address - Street 1:15222 ROBERTS WAY
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4238
Practice Address - Country:US
Practice Address - Phone:561-386-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst