Provider Demographics
NPI:1720809056
Name:DUCHIN, JONATHAN (LMHC, EMDR)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DUCHIN
Suffix:
Gender:M
Credentials:LMHC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 HERON BAY BLVD APT 1522
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1620
Mailing Address - Country:US
Mailing Address - Phone:954-732-6668
Mailing Address - Fax:
Practice Address - Street 1:1425 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1916
Practice Address - Country:US
Practice Address - Phone:954-732-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health