Provider Demographics
NPI:1457131187
Name:GOEDDE, KIMBERLY (CAP, CMHP, CBHCM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GOEDDE
Suffix:
Gender:F
Credentials:CAP, CMHP, CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 NE 206TH LN APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1876
Mailing Address - Country:US
Mailing Address - Phone:786-554-0422
Mailing Address - Fax:
Practice Address - Street 1:468 NE 206TH LN APT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-1876
Practice Address - Country:US
Practice Address - Phone:786-554-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker