MEDICARE: KIMBERLY MARQUEZ LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34012	MN

General Provider Information

NPI Number	:	1366384414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MARQUEZ LICSW

Provider Business Mailing Address
First Line	:	4070 MAUREEN DR NE UNIT 103
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-4710
Country	:	US
Telephone Number	:	612-940-1058
Fax Number	:

Provider Business Practice Location Address
First Line	:	4070 MAUREEN DR NE UNIT 103
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-4710
Country	:	US
Telephone Number	:	612-940-1058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ KIMBERLY MARQUEZ LICSW” Practice Location

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