Provider Demographics
NPI:1619668803
Name:CIME, JEAN JOHNNY
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:JOHNNY
Last Name:CIME
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 1:188 LINCOLN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2560
Mailing Address - Country:US
Mailing Address - Phone:857-243-7372
Mailing Address - Fax:
Practice Address - Street 1:188 LINCOLN ST APT 1
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2560
Practice Address - Country:US
Practice Address - Phone:857-243-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty