Provider Demographics
NPI:1003224338
Name:MONVAL, JEAN-MARY
Entity type:Individual
Prefix:
First Name:JEAN-MARY
Middle Name:
Last Name:MONVAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 S 25TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4795
Mailing Address - Country:US
Mailing Address - Phone:772-242-1079
Mailing Address - Fax:
Practice Address - Street 1:2011 S 25TH ST STE 108
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4795
Practice Address - Country:US
Practice Address - Phone:772-242-1079
Practice Address - Fax:772-242-1296
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020753600Medicaid
FL112887600Medicaid