Provider Demographics
NPI:1962000588
Name:SAWYER, KIMBERLY DENISE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:SAWYER
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 1:3001 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2203
Mailing Address - Country:US
Mailing Address - Phone:415-319-0022
Mailing Address - Fax:510-485-7173
Practice Address - Street 1:3001 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2203
Practice Address - Country:US
Practice Address - Phone:415-319-0022
Practice Address - Fax:510-485-7173
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor