Provider Demographics
NPI:1457246159
Name:JIMENEZ-VELEZ, JUANITA
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:JIMENEZ-VELEZ
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 1:418 RANDALL ST APT 9
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5412
Mailing Address - Country:US
Mailing Address - Phone:804-528-7402
Mailing Address - Fax:
Practice Address - Street 1:418 RANDALL ST APT 9
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5412
Practice Address - Country:US
Practice Address - Phone:804-528-7402
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 Licenses
StateLicense IDTaxonomies
247200000X
SCRBT-23-282250106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other