Provider Demographics
NPI:1336980788
Name:JEAN, EDDY (RBT)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 CANOPY LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9457
Mailing Address - Country:US
Mailing Address - Phone:305-917-3169
Mailing Address - Fax:888-441-6806
Practice Address - Street 1:11503 CANOPY LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9457
Practice Address - Country:US
Practice Address - Phone:305-917-3169
Practice Address - Fax:888-441-6806
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-342123106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician