Provider Demographics
NPI:1689363517
Name:JEAN, JUNIOR (MSW)
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W CLARKE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2433
Mailing Address - Country:US
Mailing Address - Phone:201-539-4824
Mailing Address - Fax:
Practice Address - Street 1:275 MAMMOTH RD STE 3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:201-539-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker