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General NPI Number Information
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NPI Number | 1801818778
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Entity Type | Individual
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Provider Name | KIMBERLEE ANN MARCIL-WIELEBA LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 2770 INDIAN RIVER BLVD SUITE 306
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City | VERO BEACH
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State | FL
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Zip | 32960
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Country | US
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Telephone | 772-299-3655
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Fax | 772-569-9303
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Provider Business Mailing Address
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Address Line | 2770 INDIAN RIVER BLVD STE 326
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City | VERO BEACH
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State | FL
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Zip | 32960-4299
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Country | US
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Telephone | 772-299-3655
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Fax | 772-569-9303
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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 | SW1816
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License Number State | FL
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