Provider Demographics
NPI:1780368571
Name:KEPNER, KIMBERLY (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KEPNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DEER PATH DR
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-5108
Mailing Address - Country:US
Mailing Address - Phone:570-764-7594
Mailing Address - Fax:
Practice Address - Street 1:12 DEER PATH DR
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-5108
Practice Address - Country:US
Practice Address - Phone:570-764-7594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136362104100000X, 1041S0200X
PACW0250931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool