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General NPI Number Information
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NPI Number | 1073135851
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Entity Type | Individual
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Provider Name | KIMBERLY RUTH CAREY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 6451 MCCALL ST STE D
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City | BONNERS FERRY
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State | ID
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Zip | 83805-8525
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Country | US
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Telephone | 208-520-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 6160 DALLAS LN
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City | BONNERS FERRY
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State | ID
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Zip | 83805-9794
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Country | US
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Telephone | 120-852-0715
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 37224
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License Number State | ID
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