Healthcare Provider Details

I. General information

NPI: 1922944800
Provider Name (Legal Business Name): DEBRA LEE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA CHRETIEN

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CHURCH ST STE 2
WHITE PLAINS NY
10601-1926
US

IV. Provider business mailing address

5 HUNDLEY CT APT 1C
STAMFORD CT
06902-3923
US

V. Phone/Fax

Practice location:
  • Phone: 203-507-5654
  • Fax:
Mailing address:
  • Phone: 203-507-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: