Provider Demographics
NPI:1184823296
Name:ROMEN, KIMBERLY KAY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAY
Last Name:ROMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4336 E SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1005
Mailing Address - Country:US
Mailing Address - Phone:480-277-0049
Mailing Address - Fax:
Practice Address - Street 1:1801 S JENTILLY LN STE A18
Practice Address - Street 2:SUITE A-18
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5762
Practice Address - Country:US
Practice Address - Phone:480-277-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-118941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical