Healthcare Provider Details

I. General information

NPI: 1699034223
Provider Name (Legal Business Name): KIM D BURSLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 WEST DIVISION ST STE F
DOVER DE
19904
US

IV. Provider business mailing address

870 HIGH STREET SUITE 2
CHESTERTOWN MD
21620
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-3366
  • Fax:
Mailing address:
  • Phone: 410-778-1099
  • Fax: 410-778-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ-1-0000508
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: