Provider Demographics
NPI:1275851594
Name:CRONENWETT, KIM (LISW-CP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CRONENWETT
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH STREET, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:1483 TOBIAS GADSON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4795
Practice Address - Country:US
Practice Address - Phone:843-745-5153
Practice Address - Fax:846-766-8606
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical