Provider Demographics
NPI:1164969077
Name:VORONIN, KIMBERLY J (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:VORONIN
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 1:572 29TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2253
Mailing Address - Country:US
Mailing Address - Phone:650-863-6285
Mailing Address - Fax:
Practice Address - Street 1:572 29TH ST APT 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2253
Practice Address - Country:US
Practice Address - Phone:650-863-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical