Provider Demographics
NPI:1932680394
Name:JIMENEZ, JEANNETTE (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2424
Mailing Address - Country:US
Mailing Address - Phone:978-277-8405
Mailing Address - Fax:
Practice Address - Street 1:70-71 N PARISH RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2914
Practice Address - Country:US
Practice Address - Phone:978-946-0714
Practice Address - Fax:978-722-8527
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1194731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical