Provider Demographics
NPI:1023059078
Name:KIMANI, STEPHEN K (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:KIMANI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 JOLIET ST
Mailing Address - Street 2:SUITE 200 B
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1724
Mailing Address - Country:US
Mailing Address - Phone:219-934-6410
Mailing Address - Fax:219-934-6420
Practice Address - Street 1:202 JOLIET ST
Practice Address - Street 2:SUITE 200 B
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1724
Practice Address - Country:US
Practice Address - Phone:219-934-6410
Practice Address - Fax:219-934-6420
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000020A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN407440AMedicare ID - Type Unspecified