Provider Demographics
NPI:1780933176
Name:VITEK, JACQUELINE DEE (LMFT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DEE
Last Name:VITEK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 37TH ST STE 112B
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6518
Mailing Address - Country:US
Mailing Address - Phone:772-300-5885
Mailing Address - Fax:
Practice Address - Street 1:1485 37TH ST STE 112B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6518
Practice Address - Country:US
Practice Address - Phone:772-300-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist