Healthcare Provider Details

I. General information

NPI: 1225965312
Provider Name (Legal Business Name): JEANETTE ALTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 LOGAN RUN RD
VALLEY HEAD WV
26294
US

IV. Provider business mailing address

PO BOX 252
VALLEY HEAD WV
26294-0252
US

V. Phone/Fax

Practice location:
  • Phone: 941-228-8817
  • Fax:
Mailing address:
  • Phone: 941-228-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: