1851404321 NPI number — KIMBERLY EVE KARANDA LCSW, PHD

Table of content: KIMBERLY EVE KARANDA LCSW, PHD (NPI 1851404321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851404321 NPI number — KIMBERLY EVE KARANDA LCSW, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARANDA
Provider First Name:
KIMBERLY
Provider Middle Name:
EVE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851404321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MEDICAL DR
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-788-0092
Provider Business Mailing Address Fax Number:
757-788-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-788-0600
Provider Business Practice Location Address Fax Number:
757-788-0932
Provider Enumeration Date:
08/17/2006

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: 1041C0700X , with the licence number:  0904003702 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1659424448 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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