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General NPI Number Information
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NPI Number | 1972539690
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Entity Type | Individual
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Provider Name | JOHANN NICHOLAS PREWETT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 08/23/2017
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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 | 3720 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3814
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Country | US
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Telephone | 904-475-2039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 4331
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY 4331
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License Number State | FL
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