Provider Demographics
NPI:1841687233
Name:MAFFEI, KIMBERLY SUE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:MAFFEI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SANDERS DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4650
Mailing Address - Country:US
Mailing Address - Phone:307-399-0435
Mailing Address - Fax:
Practice Address - Street 1:2020 E GRAND AVE STE 409
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4383
Practice Address - Country:US
Practice Address - Phone:307-399-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-11141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical