Provider Demographics
NPI:1235507864
Name:JIMENEZ, EMILY (LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-0008
Mailing Address - Country:US
Mailing Address - Phone:617-887-4194
Mailing Address - Fax:
Practice Address - Street 1:151 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1812
Practice Address - Country:US
Practice Address - Phone:617-889-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1224761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical