Provider Demographics
NPI:1720553373
Name:CARY, JAN
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:
Last Name:CARY
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 1:848 MACON DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4905
Mailing Address - Country:US
Mailing Address - Phone:321-848-2012
Mailing Address - Fax:321-268-0225
Practice Address - Street 1:848 MACON DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4905
Practice Address - Country:US
Practice Address - Phone:321-848-2012
Practice Address - Fax:321-268-0225
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty