Provider Demographics
NPI:1750092532
Name:SINIESTRO, JIMENA
Entity type:Individual
Prefix:
First Name:JIMENA
Middle Name:
Last Name:SINIESTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 CARVER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2225
Mailing Address - Country:US
Mailing Address - Phone:719-744-8892
Mailing Address - Fax:
Practice Address - Street 1:4729 CARVER ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-2225
Practice Address - Country:US
Practice Address - Phone:719-744-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-245341106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician