Provider Demographics
NPI:1437864402
Name:JOSIUS DORCENT, JERONE
Entity Type:Individual
Prefix:
First Name:JERONE
Middle Name:
Last Name:JOSIUS DORCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:5641 STRAWBERRY LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6516
Mailing Address - Country:US
Mailing Address - Phone:561-876-9407
Mailing Address - Fax:
Practice Address - Street 1:5641 STRAWBERRY LAKES CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6516
Practice Address - Country:US
Practice Address - Phone:561-876-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN22000009722Medicaid