=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033451125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY E. GLOSSBRENNER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2013
-----------------------------------------------------
Last Update Date | 03/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25283 CABOT RD #204
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-632-1119
-----------------------------------------------------
Fax | 949-452-0022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25283 CABOT RD #204
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-632-1119
-----------------------------------------------------
Fax | 949-452-0022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 20689
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------