Provider Demographics
NPI:1073135851
Name:CAREY, KIMBERLY RUTH (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RUTH
Last Name:CAREY
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 1:6160 DALLAS LN
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-9794
Mailing Address - Country:US
Mailing Address - Phone:120-852-0715
Mailing Address - Fax:
Practice Address - Street 1:6451 MCCALL ST STE D
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8525
Practice Address - Country:US
Practice Address - Phone:208-520-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID372241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical