Provider Demographics
NPI:1386230894
Name:PEERBOOM, KAMBER (LICSW)
Entity Type:Individual
Prefix:
First Name:KAMBER
Middle Name:
Last Name:PEERBOOM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5452 VERNON CT
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2408
Mailing Address - Country:US
Mailing Address - Phone:952-239-7834
Mailing Address - Fax:
Practice Address - Street 1:1150 MONTREAL AVE STE 107
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2393
Practice Address - Country:US
Practice Address - Phone:952-239-7834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health