Provider Demographics
NPI:1932601366
Name:FREMUTH, JENETTE MARIE
Entity Type:Individual
Prefix:
First Name:JENETTE
Middle Name:MARIE
Last Name:FREMUTH
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 1:744 E LINCOLN HWY STE 420
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3590
Mailing Address - Country:US
Mailing Address - Phone:610-383-5635
Mailing Address - Fax:
Practice Address - Street 1:744 E LINCOLN HWY STE 420
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3590
Practice Address - Country:US
Practice Address - Phone:610-383-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional