Provider Demographics
NPI:1609022342
Name:JIMENEZ, MARISOL WETZSTEIN (MA)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:WETZSTEIN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11688 NW 20TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5700
Mailing Address - Country:US
Mailing Address - Phone:407-754-8540
Mailing Address - Fax:
Practice Address - Street 1:11688 NW 20TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5700
Practice Address - Country:US
Practice Address - Phone:407-754-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health