Provider Demographics
NPI:1376785162
Name:JIMENEZ-MARCANO, ARACELIA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ARACELIA
Middle Name:
Last Name:JIMENEZ-MARCANO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4326
Mailing Address - Country:US
Mailing Address - Phone:631-880-3698
Mailing Address - Fax:
Practice Address - Street 1:80 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4326
Practice Address - Country:US
Practice Address - Phone:631-880-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0424661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical