Provider Demographics
NPI:1396807137
Name:ALI, KIMBERLY DONAT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DONAT
Last Name:ALI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARY
Other - Last Name:DONAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6739 1ST AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1307
Mailing Address - Country:US
Mailing Address - Phone:727-341-1000
Mailing Address - Fax:727-341-1000
Practice Address - Street 1:6739 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1307
Practice Address - Country:US
Practice Address - Phone:727-341-1000
Practice Address - Fax:727-341-1000
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6302101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4795Medicare ID - Type Unspecified