MEDICARE: KINSHIP CARE AND THERAPY LICENSE CLINICAL SOCIAL WORKER P.C

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

General Provider Information

NPI Number	:	1538926084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINSHIP CARE AND THERAPY LICENSE CLINICAL SOCIAL WORKER P.C

Provider Business Mailing Address
First Line	:	8605 SANTA MONICA BLVD
Second Line	:	PMB 231540
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-4109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1342 10TH ST APT 103
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-1938
Country	:	US
Telephone Number	:	213-255-9267
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MADELEINE E ZIMMERMAN
Credential	:	MSW, LCSW
Telephone Number	:	805-292-0649

Provider Enumeration Date	:	03/01/2024
Last Update Date	:	07/09/2024

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