Provider Demographics
NPI:1295194231
Name:JEAN-BAPTISTE, PHILIP
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:JEAN-BAPTISTE
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 1:1749 CEDAR MOUNT LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759
Mailing Address - Country:US
Mailing Address - Phone:321-697-6069
Mailing Address - Fax:
Practice Address - Street 1:1749 CEDAR MONT LOOP
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-5985
Practice Address - Country:US
Practice Address - Phone:321-697-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker