Healthcare Provider Details

I. General information

NPI: 1003739442
Provider Name (Legal Business Name): LILLIAN JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTCHESTER AVE STE 300
PURCHASE NY
10577-2554
US

IV. Provider business mailing address

2700 WESTCHESTER AVE STE 300
PURCHASE NY
10577-2554
US

V. Phone/Fax

Practice location:
  • Phone: 914-328-2868
  • Fax: 914-328-2868
Mailing address:
  • Phone: 914-328-2868
  • Fax: 914-328-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: