Individual
JISELL MARIA JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
162 WEST ST STE F, CROMWELL, CT 06416-4405
(860) 613-9930
Mailing address
42 VILLAGE WOOD DR APT 3, WATERBURY, CT 06705-5734
(203) 568-5341
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
21906528
CT
Other
Enumeration date
08/04/2017
Last updated
08/04/2017
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