Provider Demographics
NPI:1851625727
Name:JIMENEZ, COLLETTE MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:MARIE
Last Name:JIMENEZ
Suffix:
Gender:F
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:PATIO SEVILLANO # 475
Mailing Address - Street 2:CARR 8860 APT1981
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-5401
Mailing Address - Country:US
Mailing Address - Phone:787-391-5417
Mailing Address - Fax:
Practice Address - Street 1:AVE SANCHEZ OSORIO # 5H4
Practice Address - Street 2:VILLA FONTANA PARK
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3226
Practice Address - Country:US
Practice Address - Phone:787-768-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1956103TB0200X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities