Provider Demographics
NPI:1780998591
Name:JIMENEZ, MELINDA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 3RD AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2206
Mailing Address - Country:US
Mailing Address - Phone:212-289-6650
Mailing Address - Fax:212-360-6149
Practice Address - Street 1:2253 3RD AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2206
Practice Address - Country:US
Practice Address - Phone:212-289-6650
Practice Address - Fax:212-360-6149
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0703631041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool