Provider Demographics
NPI:1881728574
Name:BIERWOLF, KIM C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:C
Last Name:BIERWOLF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 TELEGRAPH RD. STE E
Mailing Address - Street 2:#144
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1572
Mailing Address - Country:US
Mailing Address - Phone:805-901-8269
Mailing Address - Fax:
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:SUITE 201
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-777-3505
Practice Address - Fax:805-777-3574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 176911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical