Provider Demographics
NPI:1184479347
Name:JIMENEZ, GABRIELA J
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:J
Last Name:JIMENEZ
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 1:4929 SKYWAY DR APT 1412
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0033
Mailing Address - Country:US
Mailing Address - Phone:646-500-1885
Mailing Address - Fax:
Practice Address - Street 1:4929 SKYWAY DR APT 1412
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-0033
Practice Address - Country:US
Practice Address - Phone:646-500-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118232104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker