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General NPI Number Information
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NPI Number | 1124771910
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Entity Type | Organization
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Legal Business Name | KIMBERLY MAFFEI LCSW, LLC
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 2020 E GRAND AVE STE 409
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City | LARAMIE
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State | WY
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Zip | 82070-4383
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Country | US
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Telephone | 307-399-0435
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Fax |
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Provider Business Mailing Address
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Address Line | 911 SANDERS DR
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City | LARAMIE
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State | WY
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Zip | 82070-4650
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Country | US
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Telephone | 307-399-0435
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | KIMBERLY MAFFEI
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Credential | LCSW
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Telephone | 307-399-0435
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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 |
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License Number State |
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