Provider Demographics
NPI:1437332228
Name:BIRRELL, KIMBERLY (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BIRRELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SEKELSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1955 US 1 S
Mailing Address - Street 2:NFSGVHS ST. AUGUSTINE CBOC, SUITE 200
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3708
Mailing Address - Country:US
Mailing Address - Phone:904-494-2841
Mailing Address - Fax:904-829-0937
Practice Address - Street 1:1955 US 1 S
Practice Address - Street 2:NFSGVHS ST. AUGUSTINE CBOC, SUITE 200
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:904-494-2841
Practice Address - Fax:904-829-0937
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081184104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker