Provider Demographics
NPI:1225262348
Name:RODGERS, KIMBERLY D (LCSW, RPT-S, CCTP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LCSW, RPT-S, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 TAMIAMI TRL N STE 406
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4459
Mailing Address - Country:US
Mailing Address - Phone:239-231-3208
Mailing Address - Fax:
Practice Address - Street 1:2335 TAMIAMI TRL N STE 406
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4459
Practice Address - Country:US
Practice Address - Phone:239-231-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW86001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical