Provider Demographics
NPI:1194609289
Name:JANNETTO, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:JANNETTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2328
Mailing Address - Country:US
Mailing Address - Phone:480-399-2058
Mailing Address - Fax:
Practice Address - Street 1:2140 W RANCHO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2328
Practice Address - Country:US
Practice Address - Phone:480-399-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional