Provider Demographics
NPI:1467092296
Name:JIMENEZ, MARIA JUANA (MA MENTAL HEALTH)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:JUANA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MA MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-2923
Mailing Address - Country:US
Mailing Address - Phone:863-206-7501
Mailing Address - Fax:
Practice Address - Street 1:255 S CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:LAKE ALFRED
Practice Address - State:FL
Practice Address - Zip Code:33850-2923
Practice Address - Country:US
Practice Address - Phone:863-206-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty