Provider Demographics
NPI:1164728481
Name:JIMENEZ, NADIA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NADIA
Middle Name:M
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 1:4885 NW 94TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5149
Mailing Address - Country:US
Mailing Address - Phone:201-820-5422
Mailing Address - Fax:954-278-8506
Practice Address - Street 1:8400 N UNIVERSITY DR STE 201
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1700
Practice Address - Country:US
Practice Address - Phone:201-820-5422
Practice Address - Fax:954-278-8506
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054467001041C0700X
FLSW115221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHV970AOtherMEDICARE PTAN