Provider Demographics
NPI:1073779450
Name:JIMENEZ, ELSIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 POLK ST
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1861
Mailing Address - Country:US
Mailing Address - Phone:908-679-9211
Mailing Address - Fax:201-869-7388
Practice Address - Street 1:7015 POLK ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-1861
Practice Address - Country:US
Practice Address - Phone:908-679-9211
Practice Address - Fax:201-869-7388
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052692001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical