Provider Demographics
NPI:1043758204
Name:JIMENEZ, ROSALYN (LMHC)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W 29TH ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5203
Mailing Address - Country:US
Mailing Address - Phone:212-564-7631
Mailing Address - Fax:212-564-7819
Practice Address - Street 1:214 W 29TH ST
Practice Address - Street 2:SUITE 703
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5203
Practice Address - Country:US
Practice Address - Phone:212-564-7631
Practice Address - Fax:212-564-7819
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health