Provider Demographics
NPI:1497245609
Name:KOERNER, KIMBERLY BETH (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BETH
Last Name:KOERNER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:BETH
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:2401 W. BELVEDERE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-601-5480
Mailing Address - Fax:410-601-5890
Practice Address - Street 1:2401 W. BELVEDERE AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-601-5480
Practice Address - Fax:410-601-5890
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical