Provider Demographics
NPI:1891379699
Name:BIONDI, KIM (LMSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BIONDI
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 1:6603 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1433
Mailing Address - Country:US
Mailing Address - Phone:718-471-8671
Mailing Address - Fax:
Practice Address - Street 1:6603 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1433
Practice Address - Country:US
Practice Address - Phone:718-471-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0826741041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical