Healthcare Provider Details

I. General information

NPI: 1295958395
Provider Name (Legal Business Name): KIMBERLY ANN VEITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 BEACHWOOD BLVD
BEACHWOOD NJ
08722-2505
US

IV. Provider business mailing address

645 BEACHWOOD BLVD
BEACHWOOD NJ
08722-2505
US

V. Phone/Fax

Practice location:
  • Phone: 732-221-1493
  • Fax:
Mailing address:
  • Phone: 732-221-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: