Provider Demographics
NPI:1396424321
Name:JEAN JACQUES, RUTH
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:JEAN JACQUES
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 1:804 NE 125TH ST # 1110
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5712
Mailing Address - Country:US
Mailing Address - Phone:786-285-0161
Mailing Address - Fax:
Practice Address - Street 1:325 NE 88TH ST
Practice Address - Street 2:
Practice Address - City:EL PORTAL
Practice Address - State:FL
Practice Address - Zip Code:33138-3104
Practice Address - Country:US
Practice Address - Phone:786-285-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist