Provider Demographics
NPI:1801818778
Name:MARCIL-WIELEBA, KIMBERLEE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:ANN
Last Name:MARCIL-WIELEBA
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 1:2770 INDIAN RIVER BLVD STE 326
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4299
Mailing Address - Country:US
Mailing Address - Phone:772-299-3655
Mailing Address - Fax:772-569-9303
Practice Address - Street 1:2770 INDIAN RIVER BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-299-3655
Practice Address - Fax:772-569-9303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW18161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3189Medicare PIN