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NPI Code Detail

MEDICARE: KIMBERLY RAE BERGLUND ACSW 123607

MEDICARE: KIMBERLY RAE BERGLUND ACSW 123607
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social Worker123707CA
3101YM0800XMental Health Counselor83111CA

General Provider Information

NPI Number : 1467929299
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY RAE BERGLUND ACSW 123607
Provider Business Mailing Address
First Line : 44 S MENTOR AVE
Second Line :
City : PASADENA
State : CA
Zip : 91106-2902
Country : US
Telephone Number : 626-795-9127
Fax Number :
Provider Business Practice Location Address
First Line : 44 S MENTOR AVE
Second Line :
City : PASADENA
State : CA
Zip : 91106-2902
Country : US
Telephone Number : 626-795-9127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2018
Last Update Date : 06/27/2024

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Directions to “ KIMBERLY RAE BERGLUND ACSW 123607” Practice Location

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