MEDICARE: MS. YVONNE JIMENEZ L.C.S.W.

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	1041C0700X	Clinical Social Worker	R037659	NY

General Provider Information

NPI Number	:	1376565457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YVONNE JIMENEZ L.C.S.W.

Provider Business Mailing Address
First Line	:	304 PARK AVE S
Second Line	:	11TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10010-4301
Country	:	US
Telephone Number	:	212-590-2391
Fax Number	:	212-590-2392

Provider Business Practice Location Address
First Line	:	304 PARK AVE S
Second Line	:	11TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10010-4301
Country	:	US
Telephone Number	:	212-590-2391
Fax Number	:	212-590-2392

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	01/06/2009

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