Provider Demographics
NPI:1598273872
Name:JEAN, BELENDY
Entity Type:Individual
Prefix:
First Name:BELENDY
Middle Name:
Last Name:JEAN
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 1:165 ASHCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2731
Mailing Address - Country:US
Mailing Address - Phone:954-673-5312
Mailing Address - Fax:
Practice Address - Street 1:165 ASHCRAFT RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2731
Practice Address - Country:US
Practice Address - Phone:954-673-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician