Provider Demographics
NPI:1003289356
Name:JIMENEZ, SOFIA CARLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:CARLEEN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 N TAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2825
Mailing Address - Country:US
Mailing Address - Phone:773-946-0993
Mailing Address - Fax:
Practice Address - Street 1:4800 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2189
Practice Address - Country:US
Practice Address - Phone:312-574-0830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical