Provider Demographics
NPI:1942221353
Name:GOLDHAMER, KIM NICOLE (LISW ICDC)
Entity Type:Individual
Prefix:MISS
First Name:KIM
Middle Name:NICOLE
Last Name:GOLDHAMER
Suffix:
Gender:F
Credentials:LISW ICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 ORANGE PL
Mailing Address - Street 2:STE 410
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4464
Mailing Address - Country:US
Mailing Address - Phone:440-708-0598
Mailing Address - Fax:440-708-0255
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:STE 410
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:440-708-0598
Practice Address - Fax:440-708-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK00053281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical