Healthcare Provider Details

I. General information

NPI: 1497270599
Provider Name (Legal Business Name): LENON JUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 10TH AVE STE 39
HIALEAH FL
33010-3766
US

IV. Provider business mailing address

5607 NW 27TH AVE STE 1
MIAMI FL
33142-2826
US

V. Phone/Fax

Practice location:
  • Phone: 305-637-6400
  • Fax: 305-636-5155
Mailing address:
  • Phone: 305-805-1700
  • Fax: 305-805-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH19591
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCMS101234
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: