Provider Demographics
NPI:1275818916
Name:SAMBERSON, KIMBERLEE
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:SAMBERSON
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 1:3801 UNIVERSITY AVE
Mailing Address - Street 2:400
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3247
Mailing Address - Country:US
Mailing Address - Phone:951-849-7142
Mailing Address - Fax:
Practice Address - Street 1:3801 UNIVERSITY AVE
Practice Address - Street 2:400
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3247
Practice Address - Country:US
Practice Address - Phone:951-849-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health