MEDICARE: NAOMI KIMMELMAN

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	106H00000X	Marriage & Family Therapist	116653	CA

General Provider Information

NPI Number	:	1912534371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI KIMMELMAN

Provider Business Mailing Address
First Line	:	PO BOX 27160
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-0160
Country	:	US
Telephone Number	:	510-761-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3085 CAPP ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2703
Country	:	US
Telephone Number	:	510-761-7011
Fax Number	:

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	05/13/2020

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Directions to “ NAOMI KIMMELMAN ” Practice Location

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