Provider Demographics
NPI:1962741579
Name:FISSETTE, JENNIFER DENISE (BSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DENISE
Last Name:FISSETTE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:DENISE
Other - Last Name:TURBIVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:2789 ORTIZ AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7806
Mailing Address - Country:US
Mailing Address - Phone:239-275-3222
Mailing Address - Fax:239-791-0111
Practice Address - Street 1:2789 ORTIZ AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7806
Practice Address - Country:US
Practice Address - Phone:239-275-3222
Practice Address - Fax:239-791-0111
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker