Provider Demographics
NPI:1134096951
Name:PESCE, KIMBERLY LOU (PHD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LOU
Last Name:PESCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23986 ALISO CREEK RD # 427
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3908
Mailing Address - Country:US
Mailing Address - Phone:714-756-6756
Mailing Address - Fax:
Practice Address - Street 1:23986 ALISO CREEK RD # 427
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3908
Practice Address - Country:US
Practice Address - Phone:714-756-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94029216103T00000X, 103TC0700X
94029216103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)