Provider Demographics
NPI:1205569423
Name:SAINT JEAN, SERGELYN I
Entity type:Individual
Prefix:
First Name:SERGELYN
Middle Name:
Last Name:SAINT JEAN
Suffix:I
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 1:11021 SW VASARI WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-6320
Mailing Address - Country:US
Mailing Address - Phone:954-243-4389
Mailing Address - Fax:
Practice Address - Street 1:11021 SW VASARI WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-6320
Practice Address - Country:US
Practice Address - Phone:954-243-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker