Provider Demographics
NPI:1518519248
Name:JEAN, CARMICHAH (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:CARMICHAH
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4040
Mailing Address - Country:US
Mailing Address - Phone:774-776-3633
Mailing Address - Fax:508-427-1588
Practice Address - Street 1:60 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4040
Practice Address - Country:US
Practice Address - Phone:774-776-3633
Practice Address - Fax:508-427-1588
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional