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General NPI Number Information
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NPI Number | 1346546132
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Entity Type | Individual
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Provider Name | KIMBERLY LOCKWOOD RUST PH.D
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Gender | Female
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 118 1/2 N. WOODLAND BLVD.
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 862-328-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 930 N FLORIDA AVE
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City | DELAND
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State | FL
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Zip | 32720-2718
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Country | US
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Telephone | 660-885-8131
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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 | SW9860
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2020020501
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License Number State | MO
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