Provider Demographics
NPI:1689148272
Name:SHERMAN, KIMBERLY ELYSE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:ELYSE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11666 MONTANA AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4636
Mailing Address - Country:US
Mailing Address - Phone:908-246-1698
Mailing Address - Fax:
Practice Address - Street 1:11666 MONTANA AVE APT 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4636
Practice Address - Country:US
Practice Address - Phone:908-246-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA869291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical