Individual
MR. ANTOINE ROGER JEANMARIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, MBA
Contact information
Practice address
2415 129TH AVE E, PARRISH, FL 34219-6940
(954) 224-4672
Mailing address
2415 129TH AVE E, PARRISH, FL 34219-6940
(954) 224-4672
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1842915
—
FL
Enumeration date
07/06/2021
Last updated
11/30/2021
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