Provider Demographics
NPI:1720238264
Name:BROWN, KIMBERLEY ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2234
Mailing Address - Country:US
Mailing Address - Phone:206-349-9823
Mailing Address - Fax:425-203-7217
Practice Address - Street 1:419 S 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2234
Practice Address - Country:US
Practice Address - Phone:206-349-9823
Practice Address - Fax:425-203-7217
Is Sole Proprietor?:No
Enumeration Date:2008-09-21
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602631421041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical