Provider Demographics
NPI:1386179679
Name:JIMENEZ, ELIZABETH (CSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1302
Mailing Address - Country:US
Mailing Address - Phone:973-572-3332
Mailing Address - Fax:
Practice Address - Street 1:13 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4159
Practice Address - Country:US
Practice Address - Phone:718-506-1115
Practice Address - Fax:888-371-0842
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC011673001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical