Healthcare Provider Details

I. General information

NPI: 1730244278
Provider Name (Legal Business Name): CELMIRA CINTRON-JIMENEZ LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 HAVEMEYER AVE FL 1
BRONX NY
10473-1140
US

IV. Provider business mailing address

171 NE 100TH ST
MIAMI SHORES FL
33138-2316
US

V. Phone/Fax

Practice location:
  • Phone: 917-600-4488
  • Fax:
Mailing address:
  • Phone: 917-734-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077358-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number073796
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077358-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: