Provider Demographics
NPI:1215760285
Name:GATTUSO, JENNIFER JUSTICE PRITIKIN (MASW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUSTICE PRITIKIN
Last Name:GATTUSO
Suffix:
Gender:F
Credentials:MASW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH ST STE E260
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7309
Mailing Address - Country:US
Mailing Address - Phone:772-220-3439
Mailing Address - Fax:
Practice Address - Street 1:900 SE OCEAN BLVD STE 340E
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3502
Practice Address - Country:US
Practice Address - Phone:772-220-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical