Healthcare Provider Details

I. General information

NPI: 1629789797
Provider Name (Legal Business Name): KIMBERLY HARDING PARK LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SCHILLER AVE STE 3, #1001
CUYAHOGA FALLS OH
44223
US

IV. Provider business mailing address

1630 SCHILLER AVE STE 3, #1001
CUYAHOGA FALLS OH
44223
US

V. Phone/Fax

Practice location:
  • Phone: 904-513-8777
  • Fax:
Mailing address:
  • Phone: 904-513-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: