Provider Demographics
NPI:1033451125
Name:GLOSSBRENNER, KIMBERLY E (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:GLOSSBRENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25283 CABOT RD
Mailing Address - Street 2:#204
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5522
Mailing Address - Country:US
Mailing Address - Phone:949-632-1119
Mailing Address - Fax:949-452-0022
Practice Address - Street 1:25283 CABOT RD
Practice Address - Street 2:#204
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5522
Practice Address - Country:US
Practice Address - Phone:949-632-1119
Practice Address - Fax:949-452-0022
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical