Provider Demographics
NPI:1114681822
Name:JEAN-SIMON, KEVIN OBED (LMSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:OBED
Last Name:JEAN-SIMON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13378 SW 264TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7788
Mailing Address - Country:US
Mailing Address - Phone:786-309-7617
Mailing Address - Fax:
Practice Address - Street 1:13378 SW 264TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7788
Practice Address - Country:US
Practice Address - Phone:786-309-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16630104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker