Healthcare Provider Details

I. General information

NPI: 1811850712
Provider Name (Legal Business Name): MIDORI KIMURA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 SUMMERVALE DR
HOLIDAY FL
34691-2537
US

IV. Provider business mailing address

3013 SUMMERVALE DR
HOLIDAY FL
34691-2537
US

V. Phone/Fax

Practice location:
  • Phone: 727-600-6159
  • Fax:
Mailing address:
  • Phone: 727-600-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW24881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: