Provider Demographics
NPI:1013296979
Name:FLECKEN, KIMBERLY (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FLECKEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ELEVENTH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6179
Mailing Address - Country:US
Mailing Address - Phone:724-334-3640
Mailing Address - Fax:724-334-3644
Practice Address - Street 1:301 ELEVENTH ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6179
Practice Address - Country:US
Practice Address - Phone:724-334-3640
Practice Address - Fax:724-334-3644
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0170031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical