Provider Demographics
NPI:1982685889
Name:JEAN, CARINE (MD)
Entity Type:Individual
Prefix:
First Name:CARINE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1635 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2717
Mailing Address - Country:US
Mailing Address - Phone:203-551-7522
Mailing Address - Fax:203-551-7037
Practice Address - Street 1:203 BROAD ST UNIT C-4
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4750
Practice Address - Country:US
Practice Address - Phone:203-880-9003
Practice Address - Fax:203-268-8075
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0339542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001339549Medicaid