MEDICARE: KIMBERLY BLACKSHEAR CALVERY 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	1041C0700X	Clinical Social Worker	CSW003853	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CSW003853	OTHER	GA	LCSW

General Provider Information

NPI Number	:	1952570079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BLACKSHEAR CALVERY LCSW

Provider Business Mailing Address
First Line	:	1777 NE LOOP 410 FL 15
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5209
Country	:	US
Telephone Number	:	210-283-4750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 NE LOOP 410 FL 15
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5209
Country	:	US
Telephone Number	:	210-283-4750
Fax Number	:

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

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	03/04/2025

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Directions to “ KIMBERLY BLACKSHEAR CALVERY LCSW” Practice Location

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