Provider Demographics
NPI:1114437852
Name:HARRIS, KIMBERLY ZELLA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ZELLA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-1224
Mailing Address - Country:US
Mailing Address - Phone:513-557-2420
Mailing Address - Fax:
Practice Address - Street 1:1841 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-1224
Practice Address - Country:US
Practice Address - Phone:513-557-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14510451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical