Provider Demographics
NPI:1083296263
Name:KIMBERLY MORET LICENSED CLINICAL SOCIAL WORKER, PC
Entity Type:Organization
Organization Name:KIMBERLY MORET LICENSED CLINICAL SOCIAL WORKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:442-294-6934
Mailing Address - Street 1:14021 AMARGOSA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6404
Mailing Address - Country:US
Mailing Address - Phone:760-513-1550
Mailing Address - Fax:760-513-9743
Practice Address - Street 1:14021 AMARGOSA RD STE 100
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6404
Practice Address - Country:US
Practice Address - Phone:760-513-1550
Practice Address - Fax:760-513-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty