Healthcare Provider Details

I. General information

NPI: 1245682269
Provider Name (Legal Business Name): KIMBERLY FIEDLER GEVINT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 76TH ST
NEW YORK NY
10021-3396
US

IV. Provider business mailing address

420 E 76TH ST
NEW YORK NY
10021-3396
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-5434
  • Fax:
Mailing address:
  • Phone: 212-434-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083260-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: