MEDICARE: KIMBERLY ANNE HARDGROVE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW7732	FL

General Provider Information

NPI Number	:	1336155100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE HARDGROVE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 403974
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-3974
Country	:	US
Telephone Number	:	813-852-3272
Fax Number	:	813-852-3233

Provider Business Practice Location Address
First Line	:	4411 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6198
Country	:	US
Telephone Number	:	727-816-9811
Fax Number	:	727-816-9865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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