Provider Demographics
NPI:1194618991
Name:JEAN BAPTISTE, CLIVENSON
Entity type:Individual
Prefix:
First Name:CLIVENSON
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 1:2102 BEVERLEY RD APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3936
Mailing Address - Country:US
Mailing Address - Phone:646-409-9843
Mailing Address - Fax:
Practice Address - Street 1:2102 BEVERLEY RD APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3936
Practice Address - Country:US
Practice Address - Phone:646-409-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician