Provider Demographics
NPI:1649781774
Name:JIMENEZ, JEISY MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:JEISY
Middle Name:MARIE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10054 MEADOWRUN DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-2878
Mailing Address - Country:US
Mailing Address - Phone:813-417-4578
Mailing Address - Fax:813-521-7415
Practice Address - Street 1:213 N PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4513
Practice Address - Country:US
Practice Address - Phone:813-407-7275
Practice Address - Fax:813-521-7415
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-43423103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-20-43423OtherBCBA