Provider Demographics
NPI:1003669615
Name:EMBE-MAMONG, KIMBERLY (MSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:EMBE-MAMONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LOUDON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2010
Mailing Address - Country:US
Mailing Address - Phone:540-246-5536
Mailing Address - Fax:
Practice Address - Street 1:41 LOUDON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2010
Practice Address - Country:US
Practice Address - Phone:540-246-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical