Provider Demographics
NPI:1003354101
Name:JEAN-PHILIPPE, FARAH
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:JEAN-PHILIPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14820 CRESCENT ROCK DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-6195
Mailing Address - Country:US
Mailing Address - Phone:305-934-7683
Mailing Address - Fax:
Practice Address - Street 1:2407 BIRDS EYE CT
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-7957
Practice Address - Country:US
Practice Address - Phone:305-934-7683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician