Provider Demographics
NPI:1922159771
Name:BROTHERTON, KIMBERLEY (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30868
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98113-0868
Mailing Address - Country:US
Mailing Address - Phone:206-353-4928
Mailing Address - Fax:
Practice Address - Street 1:180 NICKERSON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1631
Practice Address - Country:US
Practice Address - Phone:206-353-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000049271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical