Provider Demographics
NPI:1962832626
Name:EHLY, KIMBERLY (MSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:EHLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NW 51ST PL
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2923
Mailing Address - Country:US
Mailing Address - Phone:954-646-1000
Mailing Address - Fax:
Practice Address - Street 1:2611 NW 51ST PL
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2923
Practice Address - Country:US
Practice Address - Phone:954-646-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 81741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical