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NPI Code Detail

MEDICARE: MS. KIMBERLEY B. CHARLES LCSW

MEDICARE: MS. KIMBERLEY B. CHARLES 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
11041C0700XClinical Social WorkerSW14558FL

General Provider Information

NPI Number : 1639791544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLEY B. CHARLES LCSW
Provider Business Mailing Address
First Line : 14910 N DALE MABRY HWY # 340801
Second Line :
City : TAMPA
State : FL
Zip : 33618-1814
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3825 HENDERSON BLVD STE 405
Second Line :
City : TAMPA
State : FL
Zip : 33629-5012
Country : US
Telephone Number : 813-610-8378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2020
Last Update Date : 05/13/2020

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