Healthcare Provider Details

I. General information

NPI: 1114836392
Provider Name (Legal Business Name): KIM ANDREA KINDRED LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W BROAD ST
BETHLEHEM PA
18018-5248
US

IV. Provider business mailing address

5742 OAK LN
ZIONSVILLE PA
18092-2135
US

V. Phone/Fax

Practice location:
  • Phone: 484-954-8327
  • Fax:
Mailing address:
  • Phone: 484-903-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW144748
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: