Provider Demographics
NPI:1851459671
Name:KIBBEY, KIM (LSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:KIBBEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 PENNSYLVANIA AVE W
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1838
Mailing Address - Country:US
Mailing Address - Phone:814-230-9111
Mailing Address - Fax:814-313-1075
Practice Address - Street 1:1048 PENNSYLVANIA AVE W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1838
Practice Address - Country:US
Practice Address - Phone:814-230-9111
Practice Address - Fax:814-313-1075
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0164591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical