Provider Demographics
NPI:1013743673
Name:JIMENEZ, MARISE (MS, RMHCI)
Entity type:Individual
Prefix:
First Name:MARISE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 LONG LEAF LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3025
Mailing Address - Country:US
Mailing Address - Phone:305-834-9031
Mailing Address - Fax:
Practice Address - Street 1:4124 LONG LEAF LN
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3025
Practice Address - Country:US
Practice Address - Phone:305-834-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health