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General NPI Number Information
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NPI Number | 1134276140
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Entity Type | Organization
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Legal Business Name | J NICHOLAS PREWETT PHD & ASSOCIATES PA
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 1726 KINGSLEY AVE SUITE 12
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City | ORANGE PARK
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State | FL
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Zip | 32073-4463
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Country | US
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Telephone | 904-269-6071
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Fax | 904-269-6642
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Provider Business Mailing Address
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Address Line | 1726 KINGSLEY AVE SUITE 12
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City | ORANGE PARK
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State | FL
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Zip | 32073-4463
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Country | US
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Telephone | 904-269-6071
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Fax | 904-269-6642
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | JOHANN NICHOLAS PREWETT
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Credential | PH.D.
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Telephone | 904-269-6071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6231
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY4331
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License Number State | FL
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