Provider Demographics
NPI:1962890079
Name:JEAN, RENALD
Entity type:Individual
Prefix:
First Name:RENALD
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13899 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1600
Mailing Address - Country:US
Mailing Address - Phone:305-244-0971
Mailing Address - Fax:305-760-2971
Practice Address - Street 1:13899 BISCAYNE BLVD
Practice Address - Street 2:SUITE 223
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33181-1600
Practice Address - Country:US
Practice Address - Phone:305-244-0971
Practice Address - Fax:305-760-2971
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health