Provider Demographics
NPI:1295299253
Name:AMADOR, KIMBERLY R (MSW PCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:AMADOR
Suffix:
Gender:F
Credentials:MSW PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 LAKOTA TRL
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-7701
Mailing Address - Country:US
Mailing Address - Phone:307-351-0863
Mailing Address - Fax:
Practice Address - Street 1:1840 LAKOTA TRL
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-7701
Practice Address - Country:US
Practice Address - Phone:307-351-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-7791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical