=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639859390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY JEANNE MORRIS PATA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2023
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12501 IMPERIAL HWY STE 400
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-807-6265
-----------------------------------------------------
Fax | 562-807-6260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 723 N JANSS ST
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805-2569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-334-0988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 86843
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------