1326315474 NPI number — MRS. KIMBERLY KING CIMBALO LMSW

Table of content: MRS. KIMBERLY KING CIMBALO LMSW (NPI 1326315474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326315474 NPI number — MRS. KIMBERLY KING CIMBALO LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING CIMBALO
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KING
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1326315474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5118 PARK AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38117-5720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
990-145-8863
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5118 PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
990-145-8863
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  LSW0000008827 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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