Provider Demographics
NPI:1437708872
Name:JEANJEAN, MARIE (CCGC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:JEANJEAN
Suffix:
Gender:F
Credentials:CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NW 10TH AVENUE
Mailing Address - Street 2:BRB 334 (M860)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-243-4812
Mailing Address - Fax:305-243-3919
Practice Address - Street 1:1501 NW 10TH AVENUE
Practice Address - Street 2:BRB 334 (M860)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-4812
Practice Address - Fax:305-243-3919
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Single Specialty