Provider Demographics
NPI:1962900332
Name:JIMENEZ, LILIAN ESMERALDA (MED, BCBA LBA)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:ESMERALDA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MED, BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 PORTSMOUTH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2154
Mailing Address - Country:US
Mailing Address - Phone:757-292-4774
Mailing Address - Fax:757-215-2863
Practice Address - Street 1:4225 PORTSMOUTH BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2154
Practice Address - Country:US
Practice Address - Phone:757-292-4774
Practice Address - Fax:757-215-2863
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001910103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst