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General NPI Number Information
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NPI Number | 1487169561
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Entity Type | Individual
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Provider Name | KIMBERLY GLADYSZ MA
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Gender | Female
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 499 LOMA ALTA AVE BLDG 5
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City | LOS GATOS
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State | CA
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Zip | 95030
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Country | US
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Telephone | 510-333-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 499 LOMA ALTA AVE BLDG 5
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City | LOS GATOS
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State | CA
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Zip | 95030-6227
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Country | US
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Telephone | 510-333-4263
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-LCPC-LIC-27104
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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