MEDICARE: MAYDELIN JIMENEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	25940	FL

General Provider Information

NPI Number	:	1578993481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYDELIN JIMENEZ

Provider Business Mailing Address
First Line	:	100 E NEW YORK AVE STE 103
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-5576
Country	:	US
Telephone Number	:	786-587-6479
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E NEW YORK AVE STE 103
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-5576
Country	:	US
Telephone Number	:	786-587-6479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	05/17/2026

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Directions to “ MAYDELIN JIMENEZ ” Practice Location

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