1801818778 NPI number — MRS. KIMBERLEE ANN MARCIL-WIELEBA LCSW

Table of content: MRS. KIMBERLEE ANN MARCIL-WIELEBA LCSW (NPI 1801818778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801818778 NPI number — MRS. KIMBERLEE ANN MARCIL-WIELEBA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCIL-WIELEBA
Provider First Name:
KIMBERLEE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1801818778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2770 INDIAN RIVER BLVD STE 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-4299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-299-3655
Provider Business Mailing Address Fax Number:
772-569-9303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2770 INDIAN RIVER BLVD
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-299-3655
Provider Business Practice Location Address Fax Number:
772-569-9303
Provider Enumeration Date:
07/23/2006

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:  SW1816 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com