Healthcare Provider Details

I. General information

NPI: 1487119400
Provider Name (Legal Business Name): KIMBERLY KAELIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

878 FOX DR
WINCHESTER VA
22603-8613
US

IV. Provider business mailing address

878 FOX DR
WINCHESTER VA
22603-8613
US

V. Phone/Fax

Practice location:
  • Phone: 540-546-2624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019121
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW131666
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: