Provider Demographics
NPI:1366841983
Name:BOYLE, KIMBERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BOYLE
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 1:1650 S OSPREY AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2928
Mailing Address - Country:US
Mailing Address - Phone:941-917-8885
Mailing Address - Fax:941-917-8849
Practice Address - Street 1:1650 S OSPREY AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2928
Practice Address - Country:US
Practice Address - Phone:941-917-8885
Practice Address - Fax:941-917-8849
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2020-10-30
Deactivation Date:2020-09-04
Deactivation Code:
Reactivation Date:2020-09-23
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLSW160461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health