Provider Demographics
NPI:1801599337
Name:TODD, KIMBERLY BERNEICE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BERNEICE
Last Name:TODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29050 DETROIT RD APT 319
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2097
Mailing Address - Country:US
Mailing Address - Phone:216-240-4182
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 3144
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1256
Practice Address - Country:US
Practice Address - Phone:216-551-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator