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NPI Code Detail

MEDICARE: KIMBERLY RAE LSW

MEDICARE: KIMBERLY RAE LSW
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 WorkerS.1501353OH

General Provider Information

NPI Number : 1750834842
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY RAE LSW
Provider Business Mailing Address
First Line : 6753 STATE RD
Second Line :
City : PARMA
State : OH
Zip : 44134-4517
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1227 ANSEL RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-3323
Country : US
Telephone Number : 216-421-0662
Fax Number : 844-593-7239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2016
Last Update Date : 05/16/2023

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Directions to “ KIMBERLY RAE LSW” Practice Location

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