Provider Demographics
NPI:1477877736
Name:JIMENEZ, REUBEN G (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:REUBEN
Middle Name:G
Last Name:JIMENEZ
Suffix:
Gender:M
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 1:10737 78TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1104
Mailing Address - Country:US
Mailing Address - Phone:718-738-1872
Mailing Address - Fax:
Practice Address - Street 1:10737 78TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1104
Practice Address - Country:US
Practice Address - Phone:718-738-1872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR072097-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical