MEDICARE: KIMBERLY ANN PROBECK 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	104100000X	Social Worker	R0443171	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467460527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN PROBECK LCSW

Provider Business Mailing Address
First Line	:	18 NORWOOD PL
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1029
Country	:	US
Telephone Number	:	631-491-0741
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 NORWOOD PL
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1029
Country	:	US
Telephone Number	:	631-491-0741
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY ANN PROBECK LCSW” Practice Location

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