Provider Demographics
NPI:1316083173
Name:JIMENEZ, LUCILA (MA, MPHIL)
Entity type:Individual
Prefix:
First Name:LUCILA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MA, MPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 UNDERCLIFF AVE
Mailing Address - Street 2:APT. 3 A
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-7209
Mailing Address - Country:US
Mailing Address - Phone:201-945-7192
Mailing Address - Fax:201-945-2871
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:MLKP 6TH FLOOR, ROOM 6-185
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-1037
Practice Address - Fax:212-939-1035
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter