MEDICARE: KIMBERLY JULIA 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1679942031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JULIA LCSW

Provider Business Mailing Address
First Line	:	5303 FREMONT ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4017
Country	:	US
Telephone Number	:	904-383-7757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1138 EDGEWOOD AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-5369
Country	:	US
Telephone Number	:	904-383-7757
Fax Number	:

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

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	11/21/2025

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Directions to “ KIMBERLY JULIA LCSW” Practice Location

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