Provider Demographics
NPI:1518321249
Name:JIMENEZ-GOMEZ, CORINA (PHD, BCBA-D, LBA)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:JIMENEZ-GOMEZ
Suffix:
Gender:F
Credentials:PHD, BCBA-D, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 THACH HALL
Mailing Address - Street 2:
Mailing Address - City:AUBURN UNIVERSITY
Mailing Address - State:AL
Mailing Address - Zip Code:36849-0001
Mailing Address - Country:US
Mailing Address - Phone:334-844-6680
Mailing Address - Fax:
Practice Address - Street 1:101 CARY HALL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-6982
Practice Address - Country:US
Practice Address - Phone:334-844-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-21685103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst