Provider Demographics
NPI:1528759024
Name:JIMENEZ, MARIE EMMA (SWC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:EMMA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:SWC
Other - Prefix:
Other - First Name:MARIEMMA
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTER, SWC
Mailing Address - Street 1:86 TURABO CLUSTERS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-2545
Mailing Address - Country:US
Mailing Address - Phone:939-334-8840
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO TURABO CLUSTER
Practice Address - Street 2:EDFICIO B APARTMENT B-402
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:939-334-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR164281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical