Provider Demographics
NPI:1235916834
Name:BRUCCOLIERE, KIMBERLY ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:BRUCCOLIERE
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 1:35 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1655
Mailing Address - Country:US
Mailing Address - Phone:856-522-6209
Mailing Address - Fax:
Practice Address - Street 1:221 LAUREL RD STE 102
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-8301
Practice Address - Country:US
Practice Address - Phone:856-772-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker