Provider Demographics
NPI:1033736921
Name:WARNER, KIMBERLY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:WARNER
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 1:3458 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9581
Mailing Address - Country:US
Mailing Address - Phone:607-664-4660
Mailing Address - Fax:
Practice Address - Street 1:9771 UNDERWOOD LN
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-9654
Practice Address - Country:US
Practice Address - Phone:716-244-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0896351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical