Provider Demographics
NPI:1346872207
Name:ANAYA, KIMBERLY NATHALY (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NATHALY
Last Name:ANAYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 VAIL LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2984
Mailing Address - Country:US
Mailing Address - Phone:661-361-2697
Mailing Address - Fax:
Practice Address - Street 1:155 W HOSPITALITY LN STE 245
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3318
Practice Address - Country:US
Practice Address - Phone:909-939-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW897501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical