MEDICARE: JEANNETTE ELENA DIPENTO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW0002472	FL

General Provider Information

NPI Number	:	1770649576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE ELENA DIPENTO LCSW

Provider Business Mailing Address
First Line	:	303 3RD LN
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-4346
Country	:	US
Telephone Number	:	561-965-2026
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD
Second Line	:	SUITE112
City	:	GREENACRES
State	:	FL
Zip	:	33463-4727
Country	:	US
Telephone Number	:	561-963-0212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/26/2010

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