Provider Demographics
NPI:1083410559
Name:CANTWELL, KIMBERLEE SUE (MSW, PPSC)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:SUE
Last Name:CANTWELL
Suffix:
Gender:
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:SUE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2255 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3260
Mailing Address - Country:US
Mailing Address - Phone:530-538-2940
Mailing Address - Fax:
Practice Address - Street 1:2255 6TH ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3260
Practice Address - Country:US
Practice Address - Phone:530-538-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool