Provider Demographics
NPI:1356106637
Name:SUAREZ JIMENEZ, MELANIE Y
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:Y
Last Name:SUAREZ 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 1:121 W 19TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1639
Mailing Address - Country:US
Mailing Address - Phone:201-989-6987
Mailing Address - Fax:
Practice Address - Street 1:121 W 19TH ST APT 2R
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1639
Practice Address - Country:US
Practice Address - Phone:201-989-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker