Provider Demographics
NPI:1689310823
Name:SOUFFRANT, JEAN NORMAND
Entity Type:Individual
Prefix:
First Name:JEAN NORMAND
Middle Name:
Last Name:SOUFFRANT
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 1:626 E 35TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5528
Mailing Address - Country:US
Mailing Address - Phone:134-777-2567
Mailing Address - Fax:
Practice Address - Street 1:626 E 35TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5528
Practice Address - Country:US
Practice Address - Phone:134-777-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor