Provider Demographics
NPI:1528459252
Name:JIMENEZ, CHRISTIAN DEMETRIUS
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DEMETRIUS
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-3629
Mailing Address - Country:US
Mailing Address - Phone:978-702-6612
Mailing Address - Fax:
Practice Address - Street 1:287 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-3629
Practice Address - Country:US
Practice Address - Phone:978-702-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor