Provider Demographics
NPI:1801987136
Name:HAZEL, KIMBERLY C (LMSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:C
Last Name:HAZEL
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N STARKWEATHER ALY FL 3
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4690
Mailing Address - Country:US
Mailing Address - Phone:586-281-6815
Mailing Address - Fax:586-281-6816
Practice Address - Street 1:1 N STARKWEATHER ALY FL 3
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065
Practice Address - Country:US
Practice Address - Phone:586-281-6815
Practice Address - Fax:586-281-6816
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801-0654621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical