Provider Demographics
NPI:1598527988
Name:JEAN, MARC BARRYGY
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:BARRYGY
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 1:1131 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-4409
Mailing Address - Country:US
Mailing Address - Phone:561-232-1684
Mailing Address - Fax:
Practice Address - Street 1:1131 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4409
Practice Address - Country:US
Practice Address - Phone:561-232-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician