Provider Demographics
NPI:1396470795
Name:MENA JIMENEZ, ANAY SR (RBT)
Entity type:Individual
Prefix:
First Name:ANAY
Middle Name:
Last Name:MENA JIMENEZ
Suffix:SR
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 W KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3311
Mailing Address - Country:US
Mailing Address - Phone:813-756-9212
Mailing Address - Fax:
Practice Address - Street 1:2603 W KENMORE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3311
Practice Address - Country:US
Practice Address - Phone:813-756-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician