Provider Demographics
NPI:1164054466
Name:LOUBEAU, JEAN-HANS CLIFORD
Entity Type:Individual
Prefix:
First Name:JEAN-HANS
Middle Name:CLIFORD
Last Name:LOUBEAU
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 1:22201 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2122
Mailing Address - Country:US
Mailing Address - Phone:347-586-4558
Mailing Address - Fax:
Practice Address - Street 1:22201 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2122
Practice Address - Country:US
Practice Address - Phone:347-586-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician