Provider Demographics
NPI:1083890529
Name:WARMSLEY, KIMBERLY ANTIONETTE
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANTIONETTE
Last Name:WARMSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-3056
Mailing Address - Country:US
Mailing Address - Phone:209-905-8809
Mailing Address - Fax:
Practice Address - Street 1:102 S SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3213
Practice Address - Country:US
Practice Address - Phone:209-468-3810
Practice Address - Fax:209-468-2207
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA866391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker