MEDICARE: JEANNETTE DIPENTO LCSW INC

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	SW 2472	FL

General Provider Information

NPI Number	:	1912323791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANNETTE DIPENTO LCSW INC

Provider Business Mailing Address
First Line	:	5700 LAKE WORTH ROAD
Second Line	:	SUITE 110
City	:	GREENACRES
State	:	FL
Zip	:	33463-3213
Country	:	US
Telephone Number	:	561-963-0212
Fax Number	:	561-434-1615

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH ROAD
Second Line	:	SUITE 110
City	:	GREENACRES
State	:	FL
Zip	:	33463-3213
Country	:	US
Telephone Number	:	561-963-0212
Fax Number	:	561-434-1615

Authorized Official
Title or Position	:	OWNER/LCSW
Name	:	JEANNETTE DIPENTO
Credential	:	LCSW
Telephone Number	:	561-963-0212

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	12/12/2019

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