Provider Demographics
NPI:1255300026
Name:RODRIGUEZ-JIMENEZ, JENNY (PHD, MSW)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:RODRIGUEZ-JIMENEZ
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D10 CALLE TEMPLE
Mailing Address - Street 2:URB SANTA ANA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4904
Mailing Address - Country:US
Mailing Address - Phone:787-564-4839
Mailing Address - Fax:
Practice Address - Street 1:6471 AVE ISLA VERDE
Practice Address - Street 2:LOCAL 4 NEW SAN JUAN COMMERCIAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-7103
Practice Address - Country:US
Practice Address - Phone:787-564-4839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical