Healthcare Provider Details

I. General information

NPI: 1952680449
Provider Name (Legal Business Name): KIMBERLY LYNN JOYCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SW PORT ST LUCIE BLVD
PORT ST LUCIE FL
34953-1943
US

IV. Provider business mailing address

512 SW PORT ST LUCIE BLVD
PORT ST LUCIE FL
34953-1943
US

V. Phone/Fax

Practice location:
  • Phone: 772-873-8811
  • Fax: 772-873-8800
Mailing address:
  • Phone: 772-873-8811
  • Fax: 772-873-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: