MEDICARE: KIM KRAUSE L.C.S.W.

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	SW2507	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW2507	OTHER	FL	FLORIDA LICENSE

General Provider Information

NPI Number	:	1417158890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM KRAUSE L.C.S.W.

Provider Business Mailing Address
First Line	:	2816 N 46TH AVE APT J279
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2959
Country	:	US
Telephone Number	:	954-681-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 N 46TH AVE APT J279
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2959
Country	:	US
Telephone Number	:	954-681-5472
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	10/23/2024

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