Provider Demographics
NPI:1649584681
Name:JIMENEZ, RAMONITA DIAZ (EDD;MS CPSY;CPL)
Entity Type:Individual
Prefix:DR
First Name:RAMONITA
Middle Name:DIAZ
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:EDD;MS CPSY;CPL
Other - Prefix:DR
Other - First Name:RAMONITA DE LOURDES
Other - Middle Name:DIAZ
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD;MS CPSY;CPL
Mailing Address - Street 1:513 SANTANA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-6708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:513 SANTANA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-6708
Practice Address - Country:US
Practice Address - Phone:787-680-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74101YA0400X
101YP2500X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty