Provider Demographics
NPI:1851441026
Name:PIZZA, KIMBERLY S (CSC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:PIZZA
Suffix:
Gender:F
Credentials:CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E WIND DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-9629
Mailing Address - Country:US
Mailing Address - Phone:410-213-0713
Mailing Address - Fax:
Practice Address - Street 1:422 W. MARKET STREET
Practice Address - Street 2:WORCESTER COUNTY HEALTH DEPARTMENT-MARKET SQUARE
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863
Practice Address - Country:US
Practice Address - Phone:410-632-4510
Practice Address - Fax:410-632-4933
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSCO157101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MD705371101Medicaid