MEDICARE: KELSEY L TIMKO LCSW

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	ISW14759	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW20023	OTHER	FL	MEDICAL LICENSE CLINICAL SOCIAL WORKER
2	ISW14759	OTHER	FL	STATE ISSUED

General Provider Information

NPI Number	:	1801561188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY L TIMKO LCSW

Provider Business Mailing Address
First Line	:	403 SE 1ST ST
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-4540
Country	:	US
Telephone Number	:	561-332-1176
Fax Number	:	561-404-4735

Provider Business Practice Location Address
First Line	:	12443 SAN JOSE BLVD STE 604
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8652
Country	:	US
Telephone Number	:	561-266-8866
Fax Number	:	561-404-4735

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

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	09/23/2025

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Directions to “ KELSEY L TIMKO LCSW” Practice Location

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