Healthcare Provider Details

I. General information

NPI: 1033736921
Provider Name (Legal Business Name): KIMBERLY JO WARNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 INTERSTATE PKWY
BRADFORD PA
16701-1013
US

IV. Provider business mailing address

3458 RIVERSIDE DR
WELLSVILLE NY
14895-9581
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-7500
  • Fax:
Mailing address:
  • Phone: 607-664-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089635
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: