Provider Demographics
NPI:1922764315
Name:DIRZUWEIT, KIMBERLY S
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:DIRZUWEIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ALTON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2201
Mailing Address - Country:US
Mailing Address - Phone:443-206-6135
Mailing Address - Fax:
Practice Address - Street 1:107 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3304
Practice Address - Country:US
Practice Address - Phone:443-461-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional