Provider Demographics
NPI:1609645019
Name:GOODLITT-CREARY, KIMBERLY NARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NARIE
Last Name:GOODLITT-CREARY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 BRONXWOOD AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3144
Mailing Address - Country:US
Mailing Address - Phone:718-415-6260
Mailing Address - Fax:
Practice Address - Street 1:57 W BURNSIDE AVE # B1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4038
Practice Address - Country:US
Practice Address - Phone:718-716-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1225411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY122541OtherLICENSED MASTER SOCIAL WORK