Provider Demographics
NPI:1306476270
Name:JIMENEZ, ALEX (ALEX)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:ALEX
Other - Prefix:MR
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:122 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-5513
Mailing Address - Country:US
Mailing Address - Phone:973-393-8261
Mailing Address - Fax:
Practice Address - Street 1:122 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-5513
Practice Address - Country:US
Practice Address - Phone:973-393-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst