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NPI Code Detail

MEDICARE: KIMBERLY MACKAY LCSW 99074

MEDICARE: KIMBERLY MACKAY LCSW 99074
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
11041C0700XClinical Social WorkerLCSW99074CA

General Provider Information

NPI Number : 1578915997
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY MACKAY LCSW 99074
Provider Business Mailing Address
First Line : 720 WILSHIRE BLVD STE 204
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1737
Country : US
Telephone Number : 323-510-8932
Fax Number :
Provider Business Practice Location Address
First Line : 720 WILSHIRE BLVD STE 204
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1737
Country : US
Telephone Number : 323-510-8932
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2016
Last Update Date : 12/12/2025

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Directions to “ KIMBERLY MACKAY LCSW 99074” Practice Location

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