Healthcare Provider Details

I. General information

NPI: 1578438503
Provider Name (Legal Business Name): KIMBERLY TAYLOR FAMILY THERAPIST, A PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 ABBOT KINNEY BLVD STE 102
VENICE CA
90291-4839
US

IV. Provider business mailing address

PO BOX 9848
MARINA DEL REY CA
90295-2248
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-0139
  • Fax:
Mailing address:
  • Phone: 310-806-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE SILVERMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 310-806-0335