Provider Demographics
NPI:1790800381
Name:JIMENEZ, LISA CYNTHIA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:CYNTHIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:CYNTHIA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 W BRANCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-6617
Mailing Address - Country:US
Mailing Address - Phone:661-717-0644
Mailing Address - Fax:
Practice Address - Street 1:2120 CIENAGA ST
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445-9016
Practice Address - Country:US
Practice Address - Phone:805-994-2101
Practice Address - Fax:805-994-2197
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA85326104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker