Provider Demographics
NPI:1033491261
Name:VANBURCH, KIMBERLEE R (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:R
Last Name:VANBURCH
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 1:75 WEBSTER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1744
Mailing Address - Country:US
Mailing Address - Phone:201-838-5326
Mailing Address - Fax:201-339-3372
Practice Address - Street 1:1137 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3313
Practice Address - Country:US
Practice Address - Phone:201-838-5326
Practice Address - Fax:201-339-3376
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054622001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical