=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346104759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLY JIMENEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3221 KENSINGTON AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-425-6900
-----------------------------------------------------
Fax | 215-423-9600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3255 KENSINGTON AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-1935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-423-5000
-----------------------------------------------------
Fax | 215-423-9600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------