Healthcare Provider Details

I. General information

NPI: 1942184734
Provider Name (Legal Business Name): KIMBERLY ISRAEL, A LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 CARMEL MOUNTAIN RD STE D
SAN DIEGO CA
92129-2159
US

IV. Provider business mailing address

9320 CARMEL MOUNTAIN RD STE D
SAN DIEGO CA
92129-2159
US

V. Phone/Fax

Practice location:
  • Phone: 619-320-8222
  • Fax:
Mailing address:
  • Phone: 619-320-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY ISRAEL
Title or Position: FOUNDER/DIRECTOR
Credential:
Phone: 619-665-8267