Provider Demographics
NPI:1003685603
Name:BURWASH, KIMBERLY ALANA (ACSW #106839)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALANA
Last Name:BURWASH
Suffix:
Gender:F
Credentials:ACSW #106839
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CARMEL AVE
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3437
Mailing Address - Country:US
Mailing Address - Phone:701-330-7493
Mailing Address - Fax:
Practice Address - Street 1:475 CARMEL AVE
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3437
Practice Address - Country:US
Practice Address - Phone:701-330-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CAASW106839104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker