Provider Demographics
NPI:1245770924
Name:JIMENEZ, JOALEX
Entity Type:Individual
Prefix:
First Name:JOALEX
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 HOLLAND AVENUE
Mailing Address - Street 2:1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462
Mailing Address - Country:US
Mailing Address - Phone:646-708-6014
Mailing Address - Fax:
Practice Address - Street 1:1740 HOLLAND AVE
Practice Address - Street 2:1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3927
Practice Address - Country:US
Practice Address - Phone:646-708-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst