Provider Demographics
NPI:1497951461
Name:GIMENO, TALIA BINA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:BINA
Last Name:GIMENO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:TALIA
Other - Middle Name:B
Other - Last Name:BEN-AMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:6307 BRIARCLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7640
Mailing Address - Country:US
Mailing Address - Phone:310-299-1443
Mailing Address - Fax:301-315-0219
Practice Address - Street 1:6307 BRIARCLIFF WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-7640
Practice Address - Country:US
Practice Address - Phone:310-299-1443
Practice Address - Fax:301-315-0219
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040075971041C0700X
MD175381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical