Marysol Jimenez, CADC I

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

10-P-17U Issued in OR

Practice address

231 SE 12TH Ave
Portland, OR 97214-1342

Phone

(503) 546-9975

Fax

(503) 546-9976

NPI assigned

Jan 4, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central City Concern, Inc

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1548071848
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325635200000",
    "number": "1225308588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 NW 6TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093609",
            "telephone_number": "503-294-1681",
            "fax_number": "503-241-7419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 SE 12TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141342",
            "telephone_number": "503-546-9975",
            "fax_number": "503-546-9976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "MARYSOL",
        "credential": "CADC I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-04",
        "last_updated": "2012-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "10-P-17U",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Ali Jimenez
• Elizabeth Jimenez
• Jesse Angel Jimenez, CASAC
• Jessica Jimenez, FNP
• Lidia Magali Jimenez
• Nathan Quinn Jimenez, PWS
• Taranae Rachell Jimmerson
• Da Pan Jin, M.D.
• Hong Jin, L.AC, DAOM
• Justin Sungho Jin, MD

• Addiction (Substance Use Disorder) Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.