Provider Demographics
NPI:1396371803
Name:SEVCIK, KIMBERLEY (AMFT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:
Last Name:SEVCIK
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAIRMONT HOSPITAL
Mailing Address - Street 2:14500 FOOTHILL BOULEVARD
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578
Mailing Address - Country:US
Mailing Address - Phone:646-418-7173
Mailing Address - Fax:
Practice Address - Street 1:14500 FOOTHILL BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3811
Practice Address - Country:US
Practice Address - Phone:510-788-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132420106H00000X
CA117574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist