Provider Demographics
NPI:1649354978
Name:GERADS, KIMBERLY MARIE (LCSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:GERADS
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:HEINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 S. STATE COLLEGE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821
Mailing Address - Country:US
Mailing Address - Phone:763-498-3944
Mailing Address - Fax:952-746-5962
Practice Address - Street 1:135 S. STATE COLLEGE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-768-4043
Practice Address - Fax:952-746-5962
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175391041C0700X
CA703031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical