Provider Demographics
NPI:1831915743
Name:JIMENEZ, CARMEN YARITZA (LIC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:YARITZA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDA PRIMAVERA
Mailing Address - Street 2:APT.239 DD-08 CALLE BOREAL
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-0073
Mailing Address - Country:US
Mailing Address - Phone:787-615-7525
Mailing Address - Fax:
Practice Address - Street 1:HACIENDA PRIMAVERA
Practice Address - Street 2:APT.239 DD-08 CALLE BOREAL
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-0073
Practice Address - Country:US
Practice Address - Phone:787-615-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical