Provider Demographics
NPI:1538376132
Name:GEORGIOU, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:GEORGIOU
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 1:555 MAIN ST
Mailing Address - Street 2:P.O. BOX 426
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2627
Mailing Address - Country:US
Mailing Address - Phone:908-879-7554
Mailing Address - Fax:908-879-3767
Practice Address - Street 1:555 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2627
Practice Address - Country:US
Practice Address - Phone:908-879-7554
Practice Address - Fax:908-879-3767
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00302800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional