Provider Demographics
NPI:1881557262
Name:JIMENEZ, LYNE KYANNA
Entity type:Individual
Prefix:
First Name:LYNE
Middle Name:KYANNA
Last Name:JIMENEZ
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 1:59 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-4710
Mailing Address - Country:US
Mailing Address - Phone:978-871-8486
Mailing Address - Fax:
Practice Address - Street 1:59 AVENUE C
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-4710
Practice Address - Country:US
Practice Address - Phone:978-871-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor