Provider Demographics
NPI:1962061515
Name:JIMENEZ, KAELA MICHELLE (MED, NCC)
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:MICHELLE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8270 SW 116TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5136
Mailing Address - Country:US
Mailing Address - Phone:305-484-0094
Mailing Address - Fax:
Practice Address - Street 1:6405 NW 36TH ST STE 112
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6977
Practice Address - Country:US
Practice Address - Phone:305-871-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health