Provider Demographics
NPI:1033004742
Name:JIMENEZ MEREGILDO, BETHANIA EBENEZER
Entity type:Individual
Prefix:
First Name:BETHANIA
Middle Name:EBENEZER
Last Name:JIMENEZ MEREGILDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MIDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6409
Mailing Address - Country:US
Mailing Address - Phone:401-603-7238
Mailing Address - Fax:
Practice Address - Street 1:9 MIDVALE AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6409
Practice Address - Country:US
Practice Address - Phone:401-603-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health