Provider Demographics
NPI:1528502960
Name:JIMENEZ, LUISA M
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:M
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4441
Mailing Address - Country:US
Mailing Address - Phone:978-476-0723
Mailing Address - Fax:
Practice Address - Street 1:199 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1398
Practice Address - Country:US
Practice Address - Phone:978-867-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor