Provider Demographics
NPI:1518575588
Name:JIMENEZ, CARMELO (MA)
Entity Type:Individual
Prefix:MR
First Name:CARMELO
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. PARQUE DE TORRIMAR
Mailing Address - Street 2:5 ST. G-3
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8947
Mailing Address - Country:US
Mailing Address - Phone:787-688-6836
Mailing Address - Fax:
Practice Address - Street 1:168 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4782
Practice Address - Country:US
Practice Address - Phone:939-262-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1606103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling