Jacqueline Fay Jennette, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY3690 Issued in FL

Practice address

1300 Pinetree Dr
Suite 4
Indian Harbour Beach, FL 32937-4444

Phone

(321) 777-5163

Fax

(321) 777-6242

NPI assigned

Jul 9, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346273612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PINETREE DR",
            "address_2": "SUITE 4",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374444",
            "telephone_number": "321-777-5163",
            "fax_number": "321-777-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 PINETREE DR",
            "address_2": "SUITE 4",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374444",
            "telephone_number": "321-777-5163",
            "fax_number": "321-777-6242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNETTE",
        "first_name": "JACQUELINE",
        "middle_name": "FAY",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY3690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Indian Harbour Beach, FL
• Providers in Indian Harbour Beach, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.