1003111840 NPI number — MRS. AMINAH C. T. BRAHIM-JIMENEZ LISW-S

Table of content: MRS. AMINAH C. T. BRAHIM-JIMENEZ LISW-S (NPI 1003111840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003111840 NPI number — MRS. AMINAH C. T. BRAHIM-JIMENEZ LISW-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAHIM-JIMENEZ
Provider First Name:
AMINAH
Provider Middle Name:
C. T.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003111840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9826 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAGRIN FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44023-5486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-708-0188
Provider Business Mailing Address Fax Number:
440-708-0368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3737 LANDER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEPPER PIKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-5712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-831-2255
Provider Business Practice Location Address Fax Number:
216-378-3906
Provider Enumeration Date:
01/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I.0009413-SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0268768 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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